Healthcare Provider Details
I. General information
NPI: 1275828774
Provider Name (Legal Business Name): NATCHEZ EMERGENCY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
129 JEFFERSON DAVIS BLVD
NATCHEZ MS
39120-5103
US
IV. Provider business mailing address
200 CORPORATE BLVD SUITE 201
LAFAYETTE LA
70508-3870
US
V. Phone/Fax
- Phone: 601-446-7711
- Fax: 601-445-6233
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
WILLIAM
C
SCHUMACHER
Title or Position: CEO
Credential: MD
Phone: 800-893-9698