MEDICARE: POLK EMERGENCY PHYSICIANS 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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0761G	OTHER	NC	NORTH CAROLINA BLUE SHIEL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669411294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLK EMERGENCY PHYSICIANS LLC

Provider Business Mailing Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:	214-712-2444

Provider Business Practice Location Address
First Line	:	101 HOSPITAL DR
Second Line	:
City	:	COLUMBUS
State	:	NC
Zip	:	28722-6418
Country	:	US
Telephone Number	:	828-894-3311
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROSS RONAN
Credential	:
Telephone Number	:	469-401-2386

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/06/2014

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