=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326460841
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER PHOENIX EMERGENCY PHYSICIANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2014
-----------------------------------------------------
Last Update Date | 01/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7300 N 99TH AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85305-1400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-312-3604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 CONGRESS PARK DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-312-3604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. WILLIAM A. COLE JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 937-312-3604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------