Basic Information
| Provider Information | |||||||||
| NPI: | 1518394469 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIGHTED CITY EMERGENCY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WITMER RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | HORSHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190442291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154425046 | ||||||||
| FaxNumber: | 2159572875 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 N EAST ST | ||||||||
| Address2: | |||||||||
| City: | WABASH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469921914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2605692222 | ||||||||
| FaxNumber: | 2605692488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2013 | ||||||||
| LastUpdateDate: | 10/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | STONE | ||||||||
| AuthorizedOfficialFirstName: | EDDIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2154425046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
No ID Information.