COOSA RIVER EMERGENCY PHYSICIANS, PLLC - NPI NUMBER 1194088716

Summary

Provider Name: COOSA RIVER EMERGENCY PHYSICIANS, PLLC

NPI Number: 1194088716

Clasification: Emergency Medicine (207P00000X)

Address:
400 E 100TH STREET
ANNISTON, AL
ZIP 36202

Phone Number: (256) 235-5121



Detailed Information

COOSA RIVER EMERGENCY PHYSICIANS, PLLC is an emergency physician in Anniston, AL. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. The assigned NPI number for this provider is 1194088716 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

400 E 100TH STREET
ANNISTON, AL
ZIP 36202
Phone: (256) 235-5121

The provider's authorized official is Mark E Green .
The authorized official title is President/ceo and has the following contact phone number (931) 614-6379.

The enumeration date for this NPI number is 6/19/2012 and was last updated on 6/19/2012.

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207P00000X Emergency Medicine Yes

NPI Record

No. Field Name Field Value
1 NPI 1194088716
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name COOSA RIVER EMERGENCY PHYSICIANS, PLLC
5 Provider First Line Business Practice Location Address 400 E 100TH STREET
6 Provider Business Practice Location Address City Name ANNISTON
7 Provider Business Practice Location Address State Name AL
8 Provider Business Practice Location Address Postal Code 36202
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 2562355121
11 Provider Enumeration Date 6/19/2012
12 Last Update Date 6/19/2012
13 Authorized Official Last Name GREEN
14 Authorized Official First Name MARK
15 Authorized Official Middle Name E
16 Authorized Official Title or Position PRESIDENT/CEO
17 Authorized Official Telephone Number 9316146379
18 Healthcare Provider Taxonomy Code 1 207P00000X
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Organization Subpart N
21 Authorized Official Name Prefix Text DR.
22 Authorized Official Credential Text MD
23 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.