MEDICARE: MERCY EMERGENCY PHYSICIANS 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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1477825073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY EMERGENCY PHYSICIANS 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	:	937-619-4150

Provider Business Practice Location Address
First Line	:	154 HEALTH PARTNERS CIR
Second Line	:
City	:	MOUNT ORAB
State	:	OH
Zip	:	45154-8611
Country	:	US
Telephone Number	:	513-981-4700
Fax Number	:	937-619-4150

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	WILLIAM COLE
Credential	:	MD
Telephone Number	:	800-875-0136

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	01/30/2012

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