MEDICARE: EMRIS LLC

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
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1366791840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMRIS LLC

Provider Business Mailing Address
First Line	:	8921 MAXWELL PL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1517
Country	:	US
Telephone Number	:	267-974-1783
Fax Number	:

Provider Business Practice Location Address
First Line	:	8921 MAXWELL PL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1517
Country	:	US
Telephone Number	:	267-974-1783
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS NKEMDILIM OMESIETE
Credential	:	PHARM.D
Telephone Number	:	267-974-1783

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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