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General NPI Number Information
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NPI Number | 1881683548
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Entity Type | Organization
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Legal Business Name | PHOENIX EMERGENCY SERVICES OF MADISON LLC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 1 KINGS DAUGHTERS DR PHOENIX EMERGENCY SERVICES OF MADISON
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City | MADISON
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State | IN
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Zip | 47250-3300
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Country | US
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Telephone | 812-265-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 2828 CROASDAILE DR PHOENIX EMERGENCY SERVICES OF MADISON
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City | DURHAM
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State | NC
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Zip | 27705-2505
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Country | US
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Telephone | 877-751-1157
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN M. SCOTT
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Credential | MD
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Telephone | 877-751-1157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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