Basic Information
| Provider Information | |||||||||
| NPI: | 1124021316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENGLEWOOD EMERGENCY PHYSICIANS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 552142 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336550001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004768646 | ||||||||
| FaxNumber: | 9193823210 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 MEDICAL BLVD | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342233964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004768646 | ||||||||
| FaxNumber: | 9193823210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 08/10/2007 | ||||||||
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| AuthorizedOfficialLastName: | STILES | ||||||||
| AuthorizedOfficialFirstName: | KENDAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9414735000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MEDICAL DOCTOR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME70191 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34531 | 01 | FL | BCBS | OTHER |