Organization
DEKALB EMERGENCY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA FALK (VP OF CONTRACTING)
(800) 893-9698
Entity
Organization
Contact information
Practice address
200 MEDICAL CENTER DR SW, FORT PAYNE, AL 35968-3458
(256) 845-3150
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(337) 354-1153
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116633
—
AL
Enumeration date
01/11/2010
Last updated
01/11/2016
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