Healthcare Provider Details

I. General information

NPI: 1689062440
Provider Name (Legal Business Name): EMERGENCY MEDICINE SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KETTERING WAY
FRANKLIN OH
45005-1155
US

IV. Provider business mailing address

3131 NEWMARK DR STE 220
MIAMISBURG OH
45342-5400
US

V. Phone/Fax

Practice location:
  • Phone: 937-458-4700
  • Fax: 937-458-4737
Mailing address:
  • Phone: 937-436-4658
  • Fax: 937-436-4984

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: WILLIAM BRADY
Title or Position: PRESIDENT
Credential: MD
Phone: 937-438-8910