Basic Information
Provider Information | |||||||||
NPI: | 1558361584 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | LIMA EMERGENCY PHYSICIANS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
Address2: |   | ||||||||
City: | KETTERING | ||||||||
State: | OH | ||||||||
PostalCode: | 454295164 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8008750136 | ||||||||
FaxNumber: | 9376194150 | ||||||||
Practice Location | |||||||||
Address1: | 601 ST RT 224 | ||||||||
Address2: |   | ||||||||
City: | GLANDORF | ||||||||
State: | OH | ||||||||
PostalCode: | 45848 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4195396288 | ||||||||
FaxNumber: | 4192264448 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/01/2005 | ||||||||
LastUpdateDate: | 09/13/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | COLE | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 8007263627 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: | JR. | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1402093 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 2459334 | 05 | OH |   | MEDICAID | 202773900 | 01 | OH | DEPT OF LABOR GRP NUMBER | OTHER | 000000317825 | 01 | OH | BC/BS GROUP PROVIDER # | OTHER | C37096 | 01 | OH | HUMANA GRP PROVIDER # | OTHER | 203384 | 01 | OH | EEOICP GRP PROVIDER # | OTHER |