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NPI Code Detail

MEDICARE: SHADOW EMERGENCY PHYSICIANS PLLC

MEDICARE: SHADOW EMERGENCY PHYSICIANS PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184795874
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHADOW EMERGENCY PHYSICIANS PLLC
Provider Business Mailing Address
First Line : PO BOX 13917
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19101-3917
Country : US
Telephone Number : 954-939-5000
Fax Number : 877-250-6889
Provider Business Practice Location Address
First Line : 620 SHADOW LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4119
Country : US
Telephone Number : 702-388-4500
Fax Number : 877-250-6889
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : CHRISTOPHER KENNEDY
Credential :
Telephone Number : 484-213-2395
Provider Enumeration Date : 11/13/2006
Last Update Date : 01/29/2026

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Directions to “SHADOW EMERGENCY PHYSICIANS PLLC ” Practice Location

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