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General NPI Number Information
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NPI Number | 1962682997
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Entity Type | Organization
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Legal Business Name | BLAIR EMERGENCY PHYSICIANS
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 275 W 12TH ST
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City | PERU
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State | IN
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Zip | 46970-1638
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Country | US
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Telephone | 765-473-6621
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7878
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City | PHILADELPHIA
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State | PA
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Zip | 19101-7878
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Country | US
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Telephone | 800-732-1066
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Fax | 630-941-4333
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Authorized Official
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Title or Position | AUTHORIZED SIGNER
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Name | EDDIE STONE
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Credential |
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Telephone | 800-355-0808
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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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