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General NPI Number Information
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NPI Number | 1124452834
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Entity Type | Organization
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Legal Business Name | LONGLEAF PINES EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 3330 MASONIC DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3841
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Country | US
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Telephone | 318-442-1673
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Fax |
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Provider Business Mailing Address
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Address Line | 18167 US HIGHWAY 19 N SUITE 650
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City | CLEARWATER
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State | FL
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Zip | 33764-3528
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Country | US
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Telephone | 800-507-8874
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Fax | 727-536-2896
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Authorized Official
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Title or Position | VP ANCILLARY SERVICES
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Name | ROSS RONAN
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Credential |
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Telephone | 800-507-8874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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