Provider Demographics
NPI:1326097668
Name:EMERGENCY SERVICE PHYSICIANS, INC.
Entity Type:Organization
Organization Name:EMERGENCY SERVICE PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-493-4443
Mailing Address - Street 1:4535 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2545
Mailing Address - Country:US
Mailing Address - Phone:330-492-4559
Mailing Address - Fax:330-451-4035
Practice Address - Street 1:8300 EAST 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6055
Practice Address - Country:US
Practice Address - Phone:330-493-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COEMP4208OtherANTHEM BCBS
CO04001830Medicaid
CT186573902OtherOWCP
COCR0613OtherRAILROAD MEDICARE
COCR0613OtherRAILROAD MEDICARE