Healthcare Provider Details

I. General information

NPI: 1891150975
Provider Name (Legal Business Name): SOUTHERN OHIO EMERGENCY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MOUNT SAINT MARYS DR
NELSONVILLE OH
45764-1280
US

IV. Provider business mailing address

75 REMIT DR # 1122
CHICAGO IL
60675-1122
US

V. Phone/Fax

Practice location:
  • Phone: 740-753-7300
  • Fax:
Mailing address:
  • Phone: 800-210-7034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

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