=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992758247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL EMERGENCY PHYSICIAN ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 HENNESSY BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70808-4375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-926-8686
-----------------------------------------------------
Fax | 405-341-9217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | DEPT AT 952639
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31192-2639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-240-9381
-----------------------------------------------------
Fax | 405-341-9217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | BRETT MCINTYRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-602-0625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------