Healthcare Provider Details

I. General information

NPI: 1356787857
Provider Name (Legal Business Name): GENEVA EMERGENCY ROOM DOCTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2013
Last Update Date: 05/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W HOSPITAL DR
GENEVA AL
36340-1645
US

IV. Provider business mailing address

PO BOX 877
GENEVA AL
36340-0877
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-3644
  • Fax: 334-684-6472
Mailing address:
  • Phone: 334-684-3644
  • Fax: 334-684-6472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN F SIMMONS
Title or Position: OFFICER
Credential: MD
Phone: 334-684-3643