Provider Demographics
NPI:1417911892
Name:EMERGENCY PHYSICIANS OF NORTHWEST OHIO, LLC
Entity Type:Organization
Organization Name:EMERGENCY PHYSICIANS OF NORTHWEST OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-436-6648
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 1:501 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-1593
Practice Address - Country:US
Practice Address - Phone:419-436-6648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
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
OH04696OtherPARAMOUNT
OH2529599Medicaid
OH000000359586OtherANTHEM
OH740521OtherBUCKEYE COMMUNITY HEALTH
OH04696OtherPARAMOUNT
OH=========OtherTRICARE
OH=========-00OtherBWC
OH2529599Medicaid
OH04696OtherPARAMOUNT
OH=========002OtherMEDICAL MUTUAL