Organization
JELLICO EMERGENCY PHYSICIANS MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN P MARON MD (PRESIDENT)
(925) 225-5837
Entity
Organization
Contact information
Practice address
188 HOSPITAL LN, JELLICO, TN 37762-4400
(423) 784-7252
Mailing address
PO BOX 11769, WESTMINSTER, CA 92685-1769
(562) 468-0227
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1522627
—
TN
05
—
7100162540
—
KY
Enumeration date
01/10/2011
Last updated
10/15/2013
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