Healthcare Provider Details

I. General information

NPI: 1417351701
Provider Name (Legal Business Name): MERAMEC EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 10/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PLUM ST
DONIPHAN MO
63935-1277
US

IV. Provider business mailing address

75 REMIT DR # 1131
CHICAGO IL
60675-1131
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-2141
  • Fax:
Mailing address:
  • Phone: 800-210-7034
  • Fax:

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: DERIK K KING
Title or Position: LLP MANAGING PARTNER
Credential: M.D.
Phone: 866-916-5259