Organization
JACKSON PURCHASE ER PHYSICIANS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN W VANDERBOEGH MD (PRESIDENT)
(270) 444-0878
Entity
Organization
Contact information
Practice address
1530 LONE OAK RD, PADUCAH, KY 42003-7901
(270) 444-0878
(270) 444-6252
Mailing address
PO BOX 78, EVANSVILLE, IN 47701-0078
(800) 467-2394
(270) 444-6252
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65911323
—
KY
Enumeration date
09/27/2005
Last updated
06/30/2008
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