Healthcare Provider Details

I. General information

NPI: 1194176644
Provider Name (Legal Business Name): CAPITAL EMERGENCY PHYSICIANS MADISON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVER OAKS DR
CANTON MS
39046-5375
US

IV. Provider business mailing address

PO BOX 96395
OKLAHOMA CITY OK
73143-6395
US

V. Phone/Fax

Practice location:
  • Phone: 866-855-4000
  • Fax:
Mailing address:
  • Phone: 629-203-7320
  • 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: CHAD SOMERBY
Title or Position: VP OPERATIONS
Credential:
Phone: 629-203-7320