Healthcare Provider Details

I. General information

NPI: 1336393438
Provider Name (Legal Business Name): GREEN RIVER EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ASHLEY CIR
BOWLING GREEN KY
42104-3362
US

IV. Provider business mailing address

PO BOX 37758
PHILADELPHIA PA
19101-5058
US

V. Phone/Fax

Practice location:
  • Phone: 270-793-1000
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • 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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TODD G ZIMMERMAN
Title or Position: PRESIDENT
Credential:
Phone: 214-712-2000