Provider Demographics
NPI:1194760009
Name:EMERGENCY PHYSICIANS & CONSULTANTS, PA
Entity type:Organization
Organization Name:EMERGENCY PHYSICIANS & CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-442-2191
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:EMERGENCY PHYSICIANS & CONSULTANTS, PA
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-0081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1752
Practice Address - Country:US
Practice Address - Phone:952-442-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
39-22239OtherMEDICA EMERG
CS6766OtherRAILROAD MEDICARE
MN143713500Medicaid
00235001OtherPREFERRED ONE
103677OtherUCARE
66-22282OtherMEDICA - UNITED HEALTHCAR
15961OtherHEALTH PARTNERS
95852EMOtherBLUE CROSS BLUE SHIELD
00235001OtherPREFERRED ONE