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NPI Code Detail

MEDICARE: LEGATUS EMERGENCY SERVICES LLC

MEDICARE: LEGATUS EMERGENCY SERVICES 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
1207P00000XEmergency Medicine PhysicianIL

General Provider Information

NPI Number : 1588666804
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEGATUS EMERGENCY SERVICES LLC
Provider Business Mailing Address
First Line : 6800 STATE ROUTE 162
Second Line :
City : MARYVILLE
State : IL
Zip : 62062-8500
Country : US
Telephone Number : 618-288-5711
Fax Number :
Provider Business Practice Location Address
First Line : 6800 STATE ROUTE 162
Second Line :
City : MARYVILLE
State : IL
Zip : 62062-8500
Country : US
Telephone Number : 618-288-5711
Fax Number :
Authorized Official
Title or Position : HEAD OF THE GROUP
Name : CHRISTOPHER CRUZ
Credential : MD
Telephone Number : 618-288-5711
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/22/2020

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Directions to “LEGATUS EMERGENCY SERVICES LLC ” Practice Location

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