Healthcare Provider Details

I. General information

NPI: 1851441943
Provider Name (Legal Business Name): EMGI - HANCOCK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N STATE ST
GREENFIELD IN
46140-1270
US

IV. Provider business mailing address

2449 RELIABLE PKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 317-468-4415
  • Fax:
Mailing address:
  • Phone: 317-472-1147
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SHUFFLEBARGER
Title or Position: PRESIDENT
Credential: MD
Phone: 317-472-1147