Healthcare Provider Details

I. General information

NPI: 1326482266
Provider Name (Legal Business Name): BLUEFIELD EMERGENCY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHERRY ST
BLUEFIELD WV
24701-3306
US

IV. Provider business mailing address

5665 NEW NORTHSIDE DR NW SUITE 320
ATLANTA GA
30328-5831
US

V. Phone/Fax

Practice location:
  • Phone: 304-327-1100
  • Fax:
Mailing address:
  • Phone: 770-874-5439
  • Fax: 770-874-5483

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: MR. ROGER PAUL MURRAY
Title or Position: COO
Credential:
Phone: 770-874-5400