Healthcare Provider Details

I. General information

NPI: 1700114824
Provider Name (Legal Business Name): ILLINOIS/INDIANA EM-I MEDICAL SERVICES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 N GARDNER ST
SCOTTSBURG IN
47170-7751
US

IV. Provider business mailing address

PO BOX 37721
PHILADELPHIA PA
19101-5021
US

V. Phone/Fax

Practice location:
  • Phone: 812-752-3456
  • Fax:
Mailing address:
  • Phone: 800-732-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS P WEBSTER
Title or Position: OWNER
Credential: DO
Phone: 800-732-1066