Healthcare Provider Details

I. General information

NPI: 1497924500
Provider Name (Legal Business Name): GREATER SOUTHEAST COMMUNITY EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

861 SW 78TH AVE # 100-B
PLANTATION FL
33324-3273
US

V. Phone/Fax

Practice location:
  • Phone: 877-693-5700
  • Fax: 954-625-6034
Mailing address:
  • Phone: 954-693-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID S. SCHILLINGER
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 877-693-5700