Provider Demographics
NPI:1164461026
Name:EMERGENCY CARE SPECIALISTS INC
Entity Type:Organization
Organization Name:EMERGENCY CARE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRODEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-893-9271
Mailing Address - Street 1:50 QUAIL RDG
Mailing Address - Street 2:
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12300 MCCRACKEN RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2914
Practice Address - Country:US
Practice Address - Phone:216-581-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2032473Medicaid
OH2032473Medicaid