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	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	WV
2	363L00000X	Nurse Practitioner	WV
3	363LC0200X	Critical Care Medicine Nurse Practitioner	WV
4	208M00000X	Hospitalist Physician	WV

General Provider Information

NPI Number	:	1659710564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN EMERGENCY PHYSICIANS LLP

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL PARK
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-6379
Country	:	US
Telephone Number	:	304-243-3000
Fax Number	:	304-243-6317

Authorized Official
Title or Position	:	LLP MANAGING PARTNER
Name	:	DERIK K KING
Credential	:	MD
Telephone Number	:	866-916-5259

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	09/07/2017

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