Basic Information
| Provider Information | |||||||||
| NPI: | 1669706214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEGASUS EMERGENCY GROUP GADSDEN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 202708 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753202708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669356774 | ||||||||
| FaxNumber: | 7819376442 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 GOODYEAR AVE | ||||||||
| Address2: | |||||||||
| City: | GADSDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359031195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567372106 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2009 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCHAMBAN | ||||||||
| AuthorizedOfficialFirstName: | NEIL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 2567372106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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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.