Organization
EMERGENCY PROVIDERS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK PENKHUS (VICE PRESIDENT)
(615) 344-9551
Entity
Organization
Contact information
Practice address
1000 MAR WALT DR, FORT WALTON BEACH, FL 32547-6708
(850) 862-1111
Mailing address
PO BOX 741630, ATLANTA, GA 30374-1630
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
03/29/2011
Last updated
04/29/2011
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