Organization
KNOX EMERGENCY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization
Contact information
Practice address
1558 COSHOCTON AVE, MOUNT VERNON, OH 43050-5416
(740) 393-9000
(904) 805-1302
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209488
BLUE CROSS & BLUE SHIELD
OH
01
—
154184200
DEPT OF LABOR
OH
05
—
2289634
—
OH
01
—
562272748
CHAMPUS
OH
01
—
DC4085
RAIL ROAD MEDICARE
OH
Enumeration date
05/04/2006
Last updated
03/23/2022
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