Healthcare Provider Details

I. General information

NPI: 1740437995
Provider Name (Legal Business Name): SHEPHERD MOUNTAIN EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N HIGHWAY 21
PILOT KNOB MO
63663
US

IV. Provider business mailing address

PO BOX 98643
PHILADELPHIA PA
19101-8643
US

V. Phone/Fax

Practice location:
  • Phone: 573-546-1260
  • Fax:
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

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: MR. JAMES L. MURPHY
Title or Position: EXECUTIVE VICE PRESIDENT, EPP
Credential:
Phone: 214-712-2000