Provider Demographics
NPI:1356329890
Name:PROFESSIONAL EMERGENCY SPECIALISTS OF SOUTHERN OHIO
Entity Type:Organization
Organization Name:PROFESSIONAL EMERGENCY SPECIALISTS OF SOUTHERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-383-1040
Mailing Address - Street 1:PO BOX 931267
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1484
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:
Practice Address - Street 1:610 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2125
Practice Address - Country:US
Practice Address - Phone:937-383-1040
Practice Address - Fax:937-383-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty