Basic Information
| Provider Information | |||||||||
| NPI: | 1669410304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY CARE PHYSICIANS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 HONEYWOOD DR | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376041480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232828299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 PRINCETON RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376012028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238545880 | ||||||||
| FaxNumber: | 4238545685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | GOULDING | ||||||||
| AuthorizedOfficialFirstName: | CLARENCE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4232828299 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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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.