Healthcare Provider Details
I. General information
NPI: 1508835042
Provider Name (Legal Business Name): EMERGENCY GROUP OF COVINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/16/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
64030 HIGHWAY 434
LACOMBE LA
70445-3456
US
IV. Provider business mailing address
200 CORPORATE BLVD SUITE 201
LAFAYETTE LA
70508-3870
US
V. Phone/Fax
- Phone: 985-690-7696
- Fax:
- Phone: 800-893-9698
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363AM0700X |
| Taxonomy | Medical Physician Assistant |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
WILLIAM
SCHUMACHER
Title or Position: CEO
Credential: MD
Phone: 800-893-9698