Basic Information
| Provider Information | |||||||||
| NPI: | 1649384512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACS EMERGENCY PHYSICIANS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 N WINSTON RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379193606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544751300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 GOODYEAR BLVD | ||||||||
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| City: | PICAYUNE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394663221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017984711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 10/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | LANE | ||||||||
| AuthorizedOfficialFirstName: | JACKIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9544751300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 7573234 | 05 | MS | MEDICAID |