Healthcare Provider Details

I. General information

NPI: 1881683548
Provider Name (Legal Business Name): PHOENIX EMERGENCY SERVICES OF MADISON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KINGS DAUGHTERS DR PHOENIX EMERGENCY SERVICES OF MADISON
MADISON IN
47250-3300
US

IV. Provider business mailing address

2828 CROASDAILE DR PHOENIX EMERGENCY SERVICES OF MADISON
DURHAM NC
27705-2505
US

V. Phone/Fax

Practice location:
  • Phone: 812-265-5211
  • Fax:
Mailing address:
  • Phone: 877-751-1157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STEVEN M. SCOTT
Title or Position: OWNER
Credential: MD
Phone: 877-751-1157