Basic Information
| Provider Information | |||||||||
| NPI: | 1427168897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILLSIDE EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 S PALAFOX ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325025937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004447009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK DR | ||||||||
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| City: | CHESTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297069769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035813151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP, EPP, GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8003622731 | ||||||||
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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 | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP4521 | 05 | SC | MEDICAID |