Healthcare Provider Details

I. General information

NPI: 1639137847
Provider Name (Legal Business Name): STERLING EMERGENCY SERVICES OF OHIO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

IV. Provider business mailing address

PO BOX 758705
BALTIMORE MD
21275-0001
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-3335
  • Fax: 904-805-1302
Mailing address:
  • Phone: 904-805-1300
  • Fax: 904-805-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000364083
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerBLUE CROSS & BLUE SHIELD
# 2
Identifier609755300
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerDEPT OF LABOR
# 3
Identifier2540692
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 4
Identifier609755300
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerFL BLACK LUNG
# 5
IdentifierDD0243
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAIL ROAD MEDICARE

VIII. Authorized Official

Name: ROBERT J BUNKER
Title or Position: CHAIRMAN/PRESIDENT/CEO
Credential:
Phone: 904-805-1300