Basic Information
| Provider Information | |||||||||
| NPI: | 1649229212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOMBIGBEE EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13410 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191013410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003553818 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1105 EARL FRYE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMORY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388215500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622567111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 05/11/2006 | ||||||||
| NPIReactivationDate: | 06/08/2006 | ||||||||
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| AuthorizedOfficialLastName: | SUTHERLAND | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO EMCARE PHYSICIAN PROVIDERS, INC | ||||||||
| AuthorizedOfficialTelephone: | 8005078874 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.