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NPI Code Detail

MEDICARE: LONDON BRIDGE EMERGENCY PHYSICIANS

MEDICARE: LONDON BRIDGE EMERGENCY PHYSICIANS
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
1363L00000XNurse Practitioner
2363A00000XPhysician Assistant
3207P00000XEmergency Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AZ0306290OTHERAZBLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962451112
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONDON BRIDGE EMERGENCY PHYSICIANS
Provider Business Mailing Address
First Line : 3916 STATE ST
Second Line : SUITE 300
City : SANTA BARBARA
State : CA
Zip : 93105-5602
Country : US
Telephone Number : 805-563-3011
Fax Number :
Provider Business Practice Location Address
First Line : 101 CIVIC CENTER LN
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-5607
Country : US
Telephone Number : 928-453-0174
Fax Number :
Authorized Official
Title or Position : GENERAL PARTNER
Name : MR. JAMES L. MURPHY
Credential :
Telephone Number : 805-563-3011
Provider Enumeration Date : 05/07/2006
Last Update Date : 01/28/2010

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Practice Location Address:
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Practice Fax:
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Practice Location Address:
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Practice Fax: 928-302-5906
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Practice Location Address:
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1003860842 — MARK CHOREBANIAN MD
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Directions to “LONDON BRIDGE EMERGENCY PHYSICIANS ” Practice Location

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