1699732032 NPI number — ELLWOOD EMERGENCY PHYSICIANS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699732032 NPI number — ELLWOOD EMERGENCY PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLWOOD EMERGENCY PHYSICIANS INC
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:
1699732032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 951806
Provider Second Line Business Mailing Address:
ELLWOOD EMERGENCY PHYSICIANS INC
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-666-2455
Provider Business Mailing Address Fax Number:
610-660-9384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 PERSHING STREET
Provider Second Line Business Practice Location Address:
ELLWOOD CITY HOSPITAL
Provider Business Practice Location Address City Name:
ELLWOOD CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-752-6744
Provider Business Practice Location Address Fax Number:
610-617-6280
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
JEFFREY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-668-6491

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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