Provider Demographics
NPI:1609878073
Name:ADENA EMERGENCY PHYSICIANS, INC
Entity Type:Organization
Organization Name:ADENA EMERGENCY PHYSICIANS, INC
Other - Org Name:ADENA EMERGENCY PHYSICIANS INC./GREENFIELD AREA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:800-726-3627
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:550 MIRABEAU ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1617
Practice Address - Country:US
Practice Address - Phone:937-981-2116
Practice Address - Fax:937-981-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1402125207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2458040Medicaid
OH000000319598OtherANTHEM
OHC37329OtherHUMANA GRP PROVIDER#
OH202766801OtherDEPARTMENT OF LABOR GRP#
OHDA6516OtherRRMEDICARE GRP PROVIDER#
OH020407000OtherFEDERAL BLACK LUNG GRP#
OH203397OtherEEOICP GRP PROVIDER#
OHDA6516OtherRRMEDICARE GRP PROVIDER#
OH203397OtherEEOICP GRP PROVIDER#
OH=========-003OtherMEDICAL MUTUAL GRP NUMBER