Organization
PROFESSIONAL EMERGENCY PHYSICIAN SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY DAWN LIPSCOMB CPA (VIP FINANCE/CFO)
(301) 533-4201
Entity
Organization
Contact information
Practice address
251 N FOURTH ST, OAKLAND, MD 21550-1375
(301) 533-4201
(301) 533-4208
Mailing address
PO BOX 597, OAKLAND, MD 21550-4597
(301) 533-4201
(301) 533-4208
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407145000
—
MD
01
—
777A
BLUE CROSS CONSOL
—
01
—
J748
BLUE CROSS EMPIRE
—
01
—
MA6
B/C FEDERAL
—
Enumeration date
08/03/2005
Last updated
01/03/2024
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