Provider Demographics
NPI:1225015571
Name:NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC
Entity Type:Organization
Organization Name:NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-726-3627
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-4170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207P00000X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001965194OtherBLUE CROSS BLUE SHIELD
WV020358700OtherBLACK LUNG
WV001709239OtherWV BCBS (MD DO)
WV001965427OtherBLUE CROSS BLUE SHIELD
WV0203116000Medicaid
WV0203138000Medicaid
WV020358700OtherFECA
WV001709240OtherWV BCBS (NP)
WV001765432OtherBLUE CROSS BLUE SHIELD
WV001769857OtherWV BCBS (PA)
OH3042068Medicaid
WV020358700OtherENERGY
WV020358700OtherFECA
WV020358700OtherENERGY
WV0203116000Medicaid
WV001769857OtherWV BCBS (PA)
WVCH9772Medicare PIN
WV001965194OtherBLUE CROSS BLUE SHIELD
OH3042068Medicaid