Healthcare Provider Details

I. General information

NPI: 1477553584
Provider Name (Legal Business Name): GRADY EMERGENCY PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 W CENTRAL AVE
DELAWARE OH
43015-1410
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 740-369-8711
  • Fax: 740-368-5050
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1402097
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM A COLE JR.
Title or Position: CEO
Credential: MD
Phone: 800-726-3627