Provider Demographics
NPI:1427168897
Name:HILLSIDE EMERGENCY PHYSICIANS
Entity type:Organization
Organization Name:HILLSIDE EMERGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, EPP, GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-362-2731
Mailing Address - Street 1:815 S PALAFOX ST
Mailing Address - Street 2:STE 300
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5937
Mailing Address - Country:US
Mailing Address - Phone:800-444-7009
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-9769
Practice Address - Country:US
Practice Address - Phone:803-581-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4521Medicaid
SC=========OtherCHAMPUS/TRICARE
SC=========OtherBLUE SHIELD
SCGP4521Medicaid
SC8586Medicare PIN
SC=========OtherBLUE CROSS/BLUE CHOICE