NPIMap

Organization Active NPI

Jacksonville Emergency Medicine LLC

  • Emergency Medicine Physician
  • Jacksonville, AR
National Provider Identifier
1093044166
Registry record updated Dec 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
JACKSONVILLE EMERGENCY MEDICINE LLC
Practice address
1400 Braden St
Jacksonville, AR 72076-3721
Phone
(501) 985-7000
NPI assigned
Dec 18, 2009
Last updated
Dec 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ruby Frederick Yates, MD
Title
President
Phone
(318) 256-0724

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1400 Braden St
Jacksonville, AR 72076-3721

Mailing address

PO Box 11457
Daytona Beach, FL 32120-1457
Phone (386) 274-7800

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261094400000",
    "number": "1093044166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11457",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321201457",
            "telephone_number": "386-274-7800",
            "fax_number": "386-274-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BRADEN ST",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763721",
            "telephone_number": "501-985-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE EMERGENCY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-18",
        "last_updated": "2009-12-18",
        "status": "A",
        "authorized_official_last_name": "YATES",
        "authorized_official_first_name": "RUBY",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-256-0724",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.