=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497080501
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORREST CITY EMERGENCY PHYSICIANS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2009
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 NEW CASTLE RD
-----------------------------------------------------
City | FORREST CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72335-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-805-1300
-----------------------------------------------------
Fax | 904-805-1312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CORPORATE BLVD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70508-3870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-893-9698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID S SCHILLINGER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 800-893-9698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------