Healthcare Provider Details

I. General information

NPI: 1003247537
Provider Name (Legal Business Name): MERAMEC EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17651 B HWY
BOONVILLE MO
65233-2839
US

IV. Provider business mailing address

75 REMIT DRIVE 1131
CHICAGO IL
60675-1131
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-7461
  • Fax: 660-882-6093
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DERIK K KING
Title or Position: LLP MANAGING PARTNER
Credential: MD
Phone: 866-916-5259