Provider Demographics
NPI:1689602765
Name:MAHONING VALLEY EMERGENCY SPECIALISTS
Entity Type:Organization
Organization Name:MAHONING VALLEY EMERGENCY SPECIALISTS
Other - Org Name:MAHONING VALLEY EMERGENCY SPECIALISTS-MARKET ST.
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-686-2300
Mailing Address - Street 1:20010 CENTURY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1118
Mailing Address - Country:US
Mailing Address - Phone:240-686-2300
Mailing Address - Fax:240-686-2330
Practice Address - Street 1:8401 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6777
Practice Address - Country:US
Practice Address - Phone:330-729-2929
Practice Address - Fax:330-656-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2214160Medicaid
OHMA9930362Medicare ID - Type Unspecified