Healthcare Provider Details

I. General information

NPI: 1386760502
Provider Name (Legal Business Name): TEAYS VALLEY EMERGENCY PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOSPITAL DR
HURRICANE WV
25526-9202
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-1700
  • Fax: 937-619-4150
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 Number
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWV

VIII. Authorized Official

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