Healthcare Provider Details

I. General information

NPI: 1831130335
Provider Name (Legal Business Name): ERIE EMERGENCY PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7411
  • Fax: 419-696-7500
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 Number1569779
License Number StateOH

VIII. Authorized Official

Name: WILLIAM A COLE JR.
Title or Position: CEO
Credential: MD
Phone: 800-875-0136