Provider Demographics
NPI:1407810534
Name:SPRINGFIELD EMERGENCY PHYSICIANS, INC.
Entity Type:Organization
Organization Name:SPRINGFIELD EMERGENCY PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TRESURER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-325-0531
Mailing Address - Street 1:6896 W SNOWVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1412
Practice Address - Country:US
Practice Address - Phone:937-325-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000016783OtherANTHEM
OH0951457Medicaid
OH=========OtherTRICARE
OH=========-001OtherTRICARE
OH=========-02OtherBWC
OH=========-01OtherBWC
OH=========-002OtherTRICARE
OH0951457Medicaid
OH=========-00OtherBWC
OH=========OtherTRICARE