Healthcare Provider Details

I. General information

NPI: 1760857486
Provider Name (Legal Business Name): MERIDIAN EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 14TH ST
MERIDIAN MS
39301-4040
US

IV. Provider business mailing address

75 REMIT DR # 1103
CHICAGO IL
60675-1103
US

V. Phone/Fax

Practice location:
  • Phone: 601-553-6000
  • 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
# 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: DERIK K KING
Title or Position: MANAGING PARTNER
Credential:
Phone: 866-916-5259