1164461026 NPI number — EMERGENCY CARE SPECIALISTS INC

Table of content: (NPI 1164461026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164461026 NPI number — EMERGENCY CARE SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY CARE SPECIALISTS 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:
1164461026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 QUAIL RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENTLEYVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44022-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12300 MCCRACKEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARFIELD HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44125-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-581-0500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRODEN
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
440-893-9271

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2032473 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".