Healthcare Provider Details

I. General information

NPI: 1730266172
Provider Name (Legal Business Name): EMERGENCY ROOM PHYSICIANS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 VINE ST
NEW BOSTON OH
45662-4953
US

IV. Provider business mailing address

206 VINE ST
NEW BOSTON OH
45662-4953
US

V. Phone/Fax

Practice location:
  • Phone: 740-456-8231
  • Fax: 740-456-5895
Mailing address:
  • Phone: 740-456-8231
  • Fax: 740-456-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35035428
License Number StateOH

VIII. Authorized Official

Name: DAVID B HANZEL
Title or Position: OWNER
Credential: M.D.
Phone: 740-456-8231