Organization
BEN HILL EMERGENCY GROUP LLC
Active
Other names
DORMINY MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(800) 893-9698
Entity
Organization
Contact information
Practice address
200 PERRY HOUSE RD, FITZGERALD, GA 31750-8857
(800) 893-9698
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9896
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
708665600A
—
GA
Enumeration date
08/28/2006
Last updated
02/16/2016
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