Provider Demographics
NPI:1124381975
Name:BEDFORD COMMUNITY EMERGENCY CENTER
Entity Type:Organization
Organization Name:BEDFORD COMMUNITY EMERGENCY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-944-6852
Mailing Address - Street 1:22750 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1574
Mailing Address - Country:US
Mailing Address - Phone:419-944-6852
Mailing Address - Fax:440-735-2800
Practice Address - Street 1:22750 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-1574
Practice Address - Country:US
Practice Address - Phone:419-944-6852
Practice Address - Fax:440-735-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3508974261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2783680Medicaid
OH2783680Medicaid