=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073513164
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUCYRUS EMERGENCY PHYSICIANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 03/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 629 N SANDUSKY AVE
-----------------------------------------------------
City | BUCYRUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44820-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-562-4677
-----------------------------------------------------
Fax | 419-562-0987
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4750 HEMPSTEAD STATION DR
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-5164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-875-0136
-----------------------------------------------------
Fax | 937-619-4231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. WILLIAM A COLE JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 800-726-3627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 1402127
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------