MEDICARE: PEARL RIVER EMERGENCY GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	363L00000X	Nurse Practitioner
3	363AM0700X	Medical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922066190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL RIVER EMERGENCY GROUP LLC

Provider Business Mailing Address
First Line	:	200 CORPORATE BLVD
Second Line	:	SUITE 201
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-3870
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:	337-262-7246

Provider Business Practice Location Address
First Line	:	801 GOODYEAR BLVD
Second Line	:
City	:	PICAYUNE
State	:	MS
Zip	:	39466-3221
Country	:	US
Telephone Number	:	800-893-9698
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM SCHUMACHER
Credential	:	MD
Telephone Number	:	800-893-9698

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	09/11/2025

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