Healthcare Provider Details

I. General information

NPI: 1609146554
Provider Name (Legal Business Name): LITTLE RIVER EMERGENCY PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W 18TH ST
HOPKINSVILLE KY
42240
US

IV. Provider business mailing address

PO BOX 30759
CLARKSVILLE TN
37040-0013
US

V. Phone/Fax

Practice location:
  • Phone: 800-887-5762
  • Fax:
Mailing address:
  • Phone:
  • Fax: 205-313-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SOMERBY
Title or Position: VP OF OPERATIONS
Credential:
Phone: 615-928-6268