Healthcare Provider Details

I. General information

NPI: 1659679363
Provider Name (Legal Business Name): ILLINOIS/INDIANA EM-I MEDICAL SERVICES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 E WALNUT ST
WASHINGTON IN
47501-2860
US

IV. Provider business mailing address

PO BOX 80175
PHILADELPHIA PA
19101-1175
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2760
  • Fax:
Mailing address:
  • Phone: 800-355-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

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