MEDICARE: SPFLD URB 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	1371641	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020408200	OTHER	OH	FEDERAL BLACK LUNG GRP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	202821900	OTHER	OH	DEPARTMENT OF LABOR GRP #
4	203421	OTHER	OH	EEOICP GRP PROVIDER#
5	C35743	OTHER	OH	HUMANA GRP NUMBER
6	000000300375	OTHER	OH	BC/BS GRP PROVIDER NUMBER

General Provider Information

NPI Number	:	1679574552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPFLD URB 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	:	937-619-4231

Provider Business Practice Location Address
First Line	:	1343 N FOUNTAIN BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-1422
Country	:	US
Telephone Number	:	937-390-5000
Fax Number	:	937-390-5526

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/20/2008

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