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General NPI Number Information
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NPI Number | 1790015923
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Entity Type | Organization
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Legal Business Name | DEKALB EMERGENCY GROUP LLC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 200 MEDICAL CENTER DR SW
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City | FORT PAYNE
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State | AL
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Zip | 35968-3458
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Country | US
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Telephone | 256-845-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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Country | US
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Telephone | 337-354-1153
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Fax |
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Authorized Official
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Title or Position | VP OF CONTRACTING
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Name | LISHA FALK
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Credential |
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Telephone | 800-893-9698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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