Healthcare Provider Details

I. General information

NPI: 1962682997
Provider Name (Legal Business Name): BLAIR EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W 12TH ST
PERU IN
46970-1638
US

IV. Provider business mailing address

PO BOX 7878
PHILADELPHIA PA
19101-7878
US

V. Phone/Fax

Practice location:
  • Phone: 765-473-6621
  • Fax:
Mailing address:
  • Phone: 800-732-1066
  • Fax: 630-941-4333

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: EDDIE STONE
Title or Position: AUTHORIZED SIGNER
Credential:
Phone: 800-355-0808