| NPI | 1457636706 |
|---|---|
| Former Legal Business Name | ISLAND MEDICAL LOE LLC |
| Former Legal Business Name | PEGASUS EMERGENCY GROUP LOE LLC |
| Entity Type | Organization |
| Authorized Contact | MELISSA REESE Provider Enrollment Officer 855-687-0618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2023-02-24 |