MEDICARE: MOUNTAIN EMERGENCY PHYSICIANS LLP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	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	:	1518982446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN EMERGENCY PHYSICIANS LLP

Provider Business Mailing Address
First Line	:	75 REMIT DRIVE
Second Line	:	SUITE 6091
City	:	CHICAGO
State	:	IL
Zip	:	60675-6091
Country	:	US
Telephone Number	:	800-701-3381
Fax Number	:	239-939-1682

Provider Business Practice Location Address
First Line	:	333 LAIDLEY ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1614
Country	:	US
Telephone Number	:	304-347-6500
Fax Number	:	304-347-6885

Authorized Official
Title or Position	:	LLP MANAGING PARTNER
Name	:	DR. JAMES M JOHNSON
Credential	:	M.D.
Telephone Number	:	800-253-5358

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	04/07/2008

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Directions to “MOUNTAIN EMERGENCY PHYSICIANS LLP ” Practice Location

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