MEDICARE: KENTUCKY EMERGENCY MEDICINE 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
1	207P00000X	Emergency Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1477548048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENTUCKY EMERGENCY MEDICINE PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 933
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42419-0933
Country	:	US
Telephone Number	:	812-471-1591
Fax Number	:	812-471-6650

Provider Business Practice Location Address
First Line	:	1305 N ELM ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2783
Country	:	US
Telephone Number	:	270-827-7700
Fax Number	:	812-471-6650

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STANLEY P TARASKA
Credential	:	MD
Telephone Number	:	812-471-1591

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/22/2020

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