Provider Demographics
NPI:1033454483
Name:UNIVERSITY EMERGENCY SPECIALISTS LLC
Entity Type:Organization
Organization Name:UNIVERSITY EMERGENCY SPECIALISTS LLC
Other - Org Name:ALTEON HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:240-686-2300
Mailing Address - Street 1:12420 MILESTONE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-7111
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2329
Practice Address - Street 1:158 WEST MAIN ROAD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2039
Practice Address - Country:US
Practice Address - Phone:844-474-4019
Practice Address - Fax:440-735-3775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092565Medicaid