Organization
SPFLD URB EMERGENCY PHYSICIANS INC
Active
Other names
Spfld Urb Emergency Physicians Inc/Mercy Springfield
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
1343 N FOUNTAIN BLVD, SPRINGFIELD, OH 45504-1422
(937) 390-5000
(937) 390-5526
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1371641
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000300375
BC/BS GRP PROVIDER NUMBER
OH
01
—
020408200
FEDERAL BLACK LUNG GRP #
OH
01
—
202821900
DEPARTMENT OF LABOR GRP #
OH
01
—
203421
EEOICP GRP PROVIDER#
OH
05
—
2417861
—
OH
01
—
C35743
HUMANA GRP NUMBER
OH
Enumeration date
08/02/2005
Last updated
04/20/2008
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