Provider Demographics
NPI:1275129272
Name:EXECUTIVE MEDICAL CENTERS OF OHIO
Entity Type:Organization
Organization Name:EXECUTIVE MEDICAL CENTERS OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-395-3622
Mailing Address - Street 1:105 SUGAR CAMP CIR STE 140
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1979
Mailing Address - Country:US
Mailing Address - Phone:937-395-3622
Mailing Address - Fax:937-395-3646
Practice Address - Street 1:105 SUGAR CAMP CIR STE 140
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45409-1979
Practice Address - Country:US
Practice Address - Phone:937-395-3622
Practice Address - Fax:937-395-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty