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NPI Code Detail

MEDICARE: STOCKYARD EMERGENCY PHYSICIANS PLLC

MEDICARE: STOCKYARD EMERGENCY 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
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1720279672
Entity Type Code : Organization
Provider Name (Legal Business Name) : STOCKYARD EMERGENCY PHYSICIANS PLLC
Provider Business Mailing Address
First Line : PO BOX 37646
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19101-0646
Country : US
Telephone Number : 800-355-3818
Fax Number :
Provider Business Practice Location Address
First Line : 1800 PARK PLACE AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1302
Country : US
Telephone Number : 954-939-5000
Fax Number :
Authorized Official
Title or Position : OFFICER
Name : KAREN VAUGHN
Credential :
Telephone Number : 404-450-4684
Provider Enumeration Date : 08/06/2007
Last Update Date : 05/14/2024

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Directions to “STOCKYARD EMERGENCY PHYSICIANS PLLC ” Practice Location

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