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General NPI Number Information
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NPI Number | 1780167841
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Entity Type | Organization
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Legal Business Name | EMERGE MEDSTAFFING LLC
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 30 E 15TH ST
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-3459
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Country | US
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Telephone | 312-206-1064
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Fax | 708-991-2630
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Provider Business Mailing Address
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Address Line | PO BOX 786
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City | FLOSSMOOR
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State | IL
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Zip | 60422-0786
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Country | US
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Telephone | 312-206-1064
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD WATSON
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Credential | MD
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Telephone | 312-206-1064
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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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