1477553584 NPI number — GRADY 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 1477553584 NPI number — GRADY EMERGENCY PHYSICIANS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRADY 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:
1477553584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2011
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:
937-619-4150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
561 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAWARE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43015-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-369-8711
Provider Business Practice Location Address Fax Number:
740-368-5050
Provider Enumeration Date:
07/29/2005

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:  1402097 , 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: C37015 . This is a "HUMANA GRP PROVIDER#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2457827 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000316994 . This is a "BC/BS GRP PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com