Basic Information
| Provider Information | |||||||||
| NPI: | 1609825462 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHILOH EMERGENCY PHYSICIANS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 S PALAFOX ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325025937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004447009 | ||||||||
| FaxNumber: | 8003053233 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 HOSPITAL DR | ||||||||
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| City: | MC KENZIE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382011636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313525344 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 12/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | RONAN | ||||||||
| AuthorizedOfficialFirstName: | ROSS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4694012386 | ||||||||
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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 | 3731677 | 05 | TN | MEDICAID |