Healthcare Provider Details

I. General information

NPI: 1538503446
Provider Name (Legal Business Name): MISSISSIPPI EMERGENCY PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 HOSPITAL DR
CLARKSDALE MS
38614-7202
US

IV. Provider business mailing address

300 S PARK RD SUITE 400
HOLLYWOOD FL
33021-8593
US

V. Phone/Fax

Practice location:
  • Phone: 662-627-3211
  • Fax:
Mailing address:
  • Phone: 800-815-8377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID S SCHILLINGER
Title or Position: PRESIDENT
Credential: MD
Phone: 877-693-5700