Provider Demographics
NPI:1699784397
Name:EMERGENCY MEDICINE PHYSICIAN ASSOCIATES
Entity type:Organization
Organization Name:EMERGENCY MEDICINE PHYSICIAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUCKEBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-283-3993
Mailing Address - Street 1:1214 SPRING ST
Mailing Address - Street 2:#1
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3704
Mailing Address - Country:US
Mailing Address - Phone:812-283-3993
Mailing Address - Fax:812-283-7294
Practice Address - Street 1:1214 SPRING ST
Practice Address - Street 2:#1
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3704
Practice Address - Country:US
Practice Address - Phone:812-283-3993
Practice Address - Fax:812-283-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN122640Medicare ID - Type Unspecified