Basic Information
| Provider Information | |||||||||
| NPI: | 1336168483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLOOMSBURG EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 58129 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731578129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664884558 | ||||||||
| FaxNumber: | 4056071326 | ||||||||
| Practice Location | |||||||||
| Address1: | 549 E FAIR ST | ||||||||
| Address2: | |||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703872115 | ||||||||
| FaxNumber: | 4056071326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NARMI | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRINCIPAL | ||||||||
| AuthorizedOfficialTelephone: | 5703872115 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, FACP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | BL1387397 | 01 | PA | BLUE SHIELD | OTHER | 50004086 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 0019049160002 | 05 | PA | MEDICAID |