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General NPI Number Information
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NPI Number | 1245503085
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Entity Type | Organization
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Legal Business Name | FIVEMILE CREEK EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 1700 S 23RD ST
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City | FORT PIERCE
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State | FL
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Zip | 34950-4803
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Country | US
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Telephone | 772-468-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1331
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Country | US
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Telephone | 954-838-2371
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 973-251-1132
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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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