Organization · NPI-2
Moon Lake Emergency Physicians LLC
Emergency Medicine · Phenix City, AL
NPI number1831561455
StatusActive
Last updated in NPPESSep 10, 2019
Details
- NPI
- 1831561455
- Entity type
- Organization (NPI-2)
- Legal business name
- Moon Lake Emergency Physicians LLC
- Organization subpart
- No
- Enumeration date
- Oct 22, 2015
- Last updated
- Sep 10, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207P00000X | Emergency Medicine | – | – | Yes |
Practice location
4401 River Chase DrPhenix City, AL 36867-7483
Phone 469-401-2386
Mailing address
13737 Noel RdSte 1600
Dallas, TX 75240-1331
Phone 954-838-2371
Authorized official
Kathleen Kondas
Officer
9548382371
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