Healthcare Provider Details

I. General information

NPI: 1073570529
Provider Name (Legal Business Name): EMERGENCY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD METHODIST HOSP ER DEPT
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-4836
  • Fax: 317-962-8646
Mailing address:
  • Phone: 317-962-4836
  • Fax: 317-962-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES SHUFFLEBARGER
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 317-962-4836