Healthcare Provider Details

I. General information

NPI: 1508967688
Provider Name (Legal Business Name): THE ER GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 100 N
VERNAL UT
84078-2036
US

IV. Provider business mailing address

PO BOX 913
VERNAL UT
84078-0913
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-3342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRUCE DANIEL III
Title or Position: PRESIDENT
Credential: MD
Phone: 435-781-2650