MEDICARE: SYDNEYS BLUFF EMERGENCY PHYSICIANS LLC

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

General Provider Information

NPI Number	:	1831460955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYDNEYS BLUFF 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	:	313 N MAIN ST
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-1347
Country	:	US
Telephone Number	:	615-792-2452
Fax Number	:

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

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	06/04/2014

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