1437196623 NPI number — MIDWEST EMERGENCY ASSOCIATES, LLC

Table of content: DR. STEVEN EDWARD METRAS O.D. (NPI 1336231315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437196623 NPI number — MIDWEST EMERGENCY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST EMERGENCY ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437196623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637542
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-292-3000
Provider Business Mailing Address Fax Number:
865-470-0851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 BARRINGTON RD
Provider Second Line Business Practice Location Address:
ST ALEXIUS MEDICAL CENTER
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-843-2000
Provider Business Practice Location Address Fax Number:
630-734-1560
Provider Enumeration Date:
05/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLTZCLAW
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-887-4718

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ2285 . This is a "RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1437196623 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".