Organization
ACS EMERGENCY PHYSICIANS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE LANE (CFO)
(954) 475-1300
Entity
Organization
Contact information
Practice address
801 GOODYEAR BLVD, PICAYUNE, MS 39466-3221
(601) 798-4711
Mailing address
1900 N WINSTON RD, SUITE 300, KNOXVILLE, TN 37919-3606
(954) 475-1300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7573234
—
MS
Enumeration date
08/18/2006
Last updated
10/24/2007
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