Basic Information
| Provider Information | |||||||||
| NPI: | 1053358572 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARKSVILLE EMERGENCY PHYSICIANS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17304 PRESTON RD | ||||||||
| Address2: | SUITE 555 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752525618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729343200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4231 HIGHWAY 1192 | ||||||||
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| City: | MARKSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713514711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182538611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9729343200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 1449431 | 05 | LA | MEDICAID | 1900H1531Z | 01 | LA | BC/BS | OTHER |