Basic Information
| Provider Information | |||||||||
| NPI: | 1710995154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERAMEC EMERGENCY PHYSICIANS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 REMIT DRIVE | ||||||||
| Address2: | SUITE 1131 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606751131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007013381 | ||||||||
| FaxNumber: | 2399391682 | ||||||||
| Practice Location | |||||||||
| Address1: | HIGHWAY 61 SOUTH | ||||||||
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| City: | CRYSTAL CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630190350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369331000 | ||||||||
| FaxNumber: | 6369331119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 04/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | LLP MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8002535358 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.