Basic Information
| Provider Information | |||||||||
| NPI: | 1083982888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY MEDICINE SPECIALISTS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3131 NEWMARK DR STE 220 | ||||||||
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| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453425400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374364658 | ||||||||
| FaxNumber: | 9374364984 | ||||||||
| Practice Location | |||||||||
| Address1: | 1141 N MONROE DR | ||||||||
| Address2: | |||||||||
| City: | XENIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453851619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373522685 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2011 | ||||||||
| LastUpdateDate: | 11/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRADY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9374388910 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0058114 | 05 | OH | MEDICAID |