Organization
COFFEYVILLE EMERGENCY PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY MARGUETTE (CEO)
(620) 252-1537
Entity
Organization
Contact information
Practice address
1400 W 4TH ST, COFFEYVILLE, KS 67337-3306
(620) 252-1649
(620) 252-1699
Mailing address
1400 W 4TH ST, COFFEYVILLE, KS 67337-3306
(620) 252-1649
(620) 252-1699
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110385
KS BCBS GRP PROVIDER #
KS
Enumeration date
10/24/2006
Last updated
08/22/2020
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