Basic Information
| Provider Information | |||||||||
| NPI: | 1578558417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST CENTRAL EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194150 | ||||||||
| Practice Location | |||||||||
| Address1: | 3130 N DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453731337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374404600 | ||||||||
| FaxNumber: | 9373394056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8007263627 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1390644 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 202772000 | 01 | OH | DOL GROUP PROVIDER NUMBER | OTHER | 2470615 | 05 | OH | MEDICAID | C36472 | 01 | OH | GRP HUMANA/CHOICE CARE # | OTHER | 000000315959 | 01 | OH | GRP BC/BS PROVIDER NUMBER | OTHER | 020406800 | 01 | OH | FBLP GROUP PROVIDER NMBER | OTHER | 203379 | 01 | OH | EEOICP GRP PROVIDER NMBER | OTHER |