Healthcare Provider Details

I. General information

NPI: 1497808968
Provider Name (Legal Business Name): PATIENTS FIRST EMERGENCY MEDICINE CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15061 W 197TH AVE
LOWELL IN
46356-9456
US

IV. Provider business mailing address

PO BOX 678691
DALLAS TX
75267-8691
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-7049
  • Fax: 219-836-7048
Mailing address:
  • Phone: 972-758-3598
  • Fax: 972-599-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71002085A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J MACUGA
Title or Position: PRESIDENT
Credential: MD
Phone: 219-836-7049