Healthcare Provider Details

I. General information

NPI: 1649384512
Provider Name (Legal Business Name): ACS EMERGENCY PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GOODYEAR BLVD
PICAYUNE MS
39466-3221
US

IV. Provider business mailing address

1900 N WINSTON RD SUITE 300
KNOXVILLE TN
37919-3606
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-4711
  • Fax:
Mailing address:
  • Phone: 954-475-1300
  • 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: JACKIE LANE
Title or Position: CFO
Credential:
Phone: 954-475-1300