Provider Demographics
NPI:1154724862
Name:AEGIS EMERGENCY PHYSICIANS GROUP PLLC
Entity type:Organization
Organization Name:AEGIS EMERGENCY PHYSICIANS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:BLASCHKE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:615-979-9453
Mailing Address - Street 1:5400 MARYLAND WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5048
Mailing Address - Country:US
Mailing Address - Phone:615-979-9453
Mailing Address - Fax:
Practice Address - Street 1:1490 FM 2920 STE G 528
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377
Practice Address - Country:US
Practice Address - Phone:817-451-4208
Practice Address - Fax:817-563-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2650207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty