1609878073 NPI number — ADENA EMERGENCY PHYSICIANS, INC

Table of content: (NPI 1609878073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609878073 NPI number — ADENA EMERGENCY PHYSICIANS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADENA 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:
6
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:
1609878073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:
937-619-4231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 MIRABEAU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45123-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-981-2116
Provider Business Practice Location Address Fax Number:
937-981-9238
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
800-726-3627

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  1402125 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2458040 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000319598 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: C37329 . This is a "HUMANA GRP PROVIDER#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 202766801 . This is a "DEPARTMENT OF LABOR GRP#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DA6516 . This is a "RRMEDICARE GRP PROVIDER#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 020407000 . This is a "FEDERAL BLACK LUNG GRP#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 203397 . This is a "EEOICP GRP PROVIDER#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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