Healthcare Provider Details

I. General information

NPI: 1346822178
Provider Name (Legal Business Name): PAPILLION EMERGENCY PHYSICIANS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 PINNACLE DR
PAPILLION NE
68046-6242
US

IV. Provider business mailing address

1464 E WHITESTONE BLVD STE 1101
CEDAR PARK TX
78613-9070
US

V. Phone/Fax

Practice location:
  • Phone: 512-686-5351
  • Fax:
Mailing address:
  • Phone: 512-686-5351
  • 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 Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSIE WILLIAMSON
Title or Position: VP OF OPERATIONS AND FINANCE
Credential:
Phone: 512-686-5351