Healthcare Provider Details

I. General information

NPI: 1689072779
Provider Name (Legal Business Name): SOUTHERN OHIO EMERGENCY PHYSICIANS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

75 REMIT DR # 1122
CHICAGO IL
60675-1122
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5000
  • Fax: 740-446-5522
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

VIII. Authorized Official

Name: DERIK K KING
Title or Position: MANAGING PARTNER
Credential:
Phone: 866-916-5259