Organization
GRADY EMERGENCY PHYSICIANS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM A COLE JR. MD (CEO)
(800) 726-3627
Entity
Organization
Contact information
Practice address
561 W CENTRAL AVE, DELAWARE, OH 43015-1410
(740) 369-8711
(740) 368-5050
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1402097
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316994
BC/BS GRP PROVIDER NUMBER
OH
05
—
2457827
—
OH
01
—
C37015
HUMANA GRP PROVIDER#
OH
Enumeration date
07/29/2005
Last updated
08/25/2011
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