Healthcare Provider Details

I. General information

NPI: 1528003316
Provider Name (Legal Business Name): ELIZABETHTOWN EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 N DIXIE AVE
ELIZABETHTOWN KY
42701-2503
US

IV. Provider business mailing address

PO BOX 950112 DEPT. #52387
LOUISVILLE KY
40295-0112
US

V. Phone/Fax

Practice location:
  • Phone: 877-783-6257
  • Fax:
Mailing address:
  • Phone: 888-400-8870
  • Fax: 317-870-0499

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 Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GILBERT
Title or Position: PRESIDENT
Credential: MD
Phone: 888-400-8870