Basic Information
| Provider Information | |||||||||
| NPI: | 1043493240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PITTSBURG EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2785 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662012785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134694244 | ||||||||
| FaxNumber: | 9134691939 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MT CARMEL WAY | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667627587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134694244 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | HOLCOMB | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9134694244 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.