Basic Information
| Provider Information | |||||||||
| NPI: | 1467616862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUSE RIVER EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18167 US 19 N | ||||||||
| Address2: | SUITE 285 | ||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337643528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005078874 | ||||||||
| FaxNumber: | 7275073618 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ROXBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275734629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365992121 | ||||||||
| FaxNumber: | 3365035739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2008 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2147122000 | ||||||||
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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 | 5950328 | 05 | NC | MEDICAID |