Basic Information
| Provider Information | |||||||||
| NPI: | 1164461026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY CARE SPECIALISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 QUAIL RDG | ||||||||
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| City: | BENTLEYVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440223606 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12300 MCCRACKEN RD | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441252914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165810500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | BRODEN | ||||||||
| AuthorizedOfficialFirstName: | BRADFORD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4408939271 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 2032473 | 05 | OH | MEDICAID |