Healthcare Provider Details

I. General information

NPI: 1700872728
Provider Name (Legal Business Name): QUALIFIED EMERGENCY SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

10506 MONTGOMERY RD SUITE #209
CINCINNATI OH
45242-4487
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1307
  • Fax:
Mailing address:
  • Phone: 513-865-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J BAIN
Title or Position: PRESIDENT
Credential: MD
Phone: 513-865-9040