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1396722641

NPI Code Detail

MEDICARE: NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC

MEDICARE: NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner		WV
2	363A00000X	Physician Assistant		WV
3	207P00000X	Emergency Medicine Physician		WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001769857	OTHER	WV	WV BCBS (PA)
2	001965204	OTHER	WV	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	001709240	OTHER	WV	WV BCBS (NP)
6	001709239	OTHER	WV	WV BCBS (MD DO)
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	001965433	OTHER	WV	BLUE CROSS BLUE SHIELD
9	150778001	OTHER	WV	DEPARTMENT OF LABOR
10	001965430	OTHER	WV	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1396722641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC

Provider Business Mailing Address
First Line	:	4750 HEMPSTEAD STATION DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-5164
Country	:	US
Telephone Number	:	800-875-0136
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 PENNSYLVANIA AVE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-3351
Country	:	US
Telephone Number	:	304-388-2550
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. WILLIAM A COLE JR.
Credential	:	MD
Telephone Number	:	800-726-3627

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	09/15/2010

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Practice Location Address:

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Practice Fax:

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1265419279 — DR. KIMBERLY EWING MD
Practice Location Address:

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Directions to “NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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