Healthcare Provider Details

I. General information

NPI: 1881953297
Provider Name (Legal Business Name): BEDFORD COMMUNITY EMERGENCY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22750 ROCKSIDE RD
BEDFORD OH
44146-1574
US

IV. Provider business mailing address

22750 ROCKSIDE RD
BEDFORD OH
44146-1574
US

V. Phone/Fax

Practice location:
  • Phone: 440-439-0086
  • Fax:
Mailing address:
  • Phone: 440-439-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: CHERYLE POLO
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 440-234-8833