Healthcare Provider Details

I. General information

NPI: 1659604254
Provider Name (Legal Business Name): ELECTRIC CITY EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W NURSERY ST
BUTLER MO
64730-1840
US

IV. Provider business mailing address

PO BOX 2257
SHAWNEE MISSION KS
66201-1257
US

V. Phone/Fax

Practice location:
  • Phone: 660-200-7000
  • Fax: 660-200-7004
Mailing address:
  • Phone: 913-469-4244
  • Fax: 913-469-1936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK S HOLCOMB
Title or Position: PARTNER
Credential: MD
Phone: 913-469-1441