Provider Demographics
NPI:1679574552
Name:SPFLD URB EMERGENCY PHYSICIANS INC
Entity type:Organization
Organization Name:SPFLD URB EMERGENCY PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-726-3627
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:1343 N FOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1422
Practice Address - Country:US
Practice Address - Phone:937-390-5000
Practice Address - Fax:937-390-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1371641207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020408200OtherFEDERAL BLACK LUNG GRP #
OH2417861Medicaid
OH202821900OtherDEPARTMENT OF LABOR GRP #
OH203421OtherEEOICP GRP PROVIDER#
OHC35743OtherHUMANA GRP NUMBER
OH000000300375OtherBC/BS GRP PROVIDER NUMBER
OH020408200OtherFEDERAL BLACK LUNG GRP #
OH202821900OtherDEPARTMENT OF LABOR GRP #
OH000000300375OtherBC/BS GRP PROVIDER NUMBER
OHDA2115Medicare PIN