Organization
BLAIR EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDDIE STONE (AUTHORIZED SIGNER)
(800) 355-0808
Entity
Organization
Contact information
Practice address
275 W 12TH ST, PERU, IN 46970-1638
(765) 473-6621
Mailing address
PO BOX 7878, PHILADELPHIA, PA 19101-7878
(800) 732-1066
(630) 941-4333
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000327623
BLUE SHIELD
IN
05
—
200333950A
—
IN
Enumeration date
11/07/2007
Last updated
06/19/2008
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