Ethan R Freeborn (NPI# 1336338656, PAC ID# 4688754757) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is EMERGENCY MEDICINE.
| Nation Provider ID (NPI) | 1336338656 |
| PAC ID by PECOS | 4688754757 |
| Professional Enrollment ID | I20071231000574 |
| Full Name | Ethan R Freeborn |
| Organization Legal Name | LAKE SPRING EMERGENCY GROUP LLC |
| Address |
2706 Ogden Rd Cave Spring VA 24018-0600 |
| Phone Number | 5409708000 |
| Gender | M |
| Medical School | UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE |
| Graduation Year | 2004 |
| Primary Specialty | EMERGENCY MEDICINE |
| Group Practice PAC ID | 6406103498 |
| Number of Group Practice Members | 28 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 490048 | LEWISGALE MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 2706 Ogden Rd, Cave Spring, VA 24018-0600 | 5409708000 | LAKE SPRING EMERGENCY GROUP LLC |
| 1900 Electric Rd, Salem, VA 24153-7474 | 5407764000 | LAKE SPRING EMERGENCY GROUP LLC |
| Organization Legal Name | LAKE SPRING EMERGENCY GROUP LLC |
| Physicians | 23 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Matthew Bailey | Nurse Practitioner | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| David Champ | Emergency Medicine | Lake Spring Emergency Group LLC | 1900 Electric Rd, Salem, VA 24153-7474 |
| Kimberley Kay Buff | Nurse Practitioner | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Jeffrey W Horton | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Eliza A Jacob | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Thomas B Bolton | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Eric D Kramer | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Nicole M Socha-coleman | Nurse Practitioner | Lake Spring Emergency Group LLC | 1900 Electric Rd, Salem, VA 24153-7474 |
| Chad W Mosby | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Jeremy J Webb | Emergency Medicine | Lake Spring Emergency Group LLC | 1900 Electric Rd, Salem, VA 24153-7474 |
| Street Address |
2706 OGDEN RD |
| City | CAVE SPRING |
| State | VA |
| Zip | 24018-0600 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Matthew Bailey | Nurse Practitioner | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Kimberley Kay Buff | Nurse Practitioner | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Jeffrey W Horton | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Eliza A Jacob | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Thomas B Bolton | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Eric D Kramer | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Chad W Mosby | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Daniel Patrick Sapp | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| David Long | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| William Thomas Burnett | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Travis Maule | Nurse Practitioner | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Lance Michael Varga | Nurse Practitioner | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Bruce Alfred St Amour Jr. | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Danh T Nguyen | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Mark T Smith | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Paul V Offerman | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| James M Harless | Emergency Medicine | Lake Spring Emergency Group LLC | 2706 Ogden Rd, Cave Spring, VA 24018-0600 |
| Philip J Mollica Ii | Chiropractic | 4370 Starkey Rd, Suite 2, Roanoke, VA 24018-0603 | |
| Joan Landolt | Clinical Social Worker | 4370 Starkey Rd, Suite 4e, Roanoke, VA 24018-0603 | |
| Darnell T Barnes | Clinical Social Worker | 4346 Starkey Rd, Suite 1, Roanoke, VA 24018-0605 | |
| Find all physicians in zip 24018 | |||
| City | CAVE SPRING |
| Zip Code | 24018 |
| Specialty | EMERGENCY MEDICINE |
| City + Specialty | CAVE SPRING + EMERGENCY MEDICINE |
Please comment or provide details below to improve the information on Ethan R Freeborn.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.