Provider Demographics
NPI:1710274105
Name:BEDFORD COMMUNITY EMERGENCY ROOM, LLC
Entity Type:Organization
Organization Name:BEDFORD COMMUNITY EMERGENCY ROOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-944-6886
Mailing Address - Street 1:22750 ROCKSIDE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1574
Mailing Address - Country:US
Mailing Address - Phone:419-944-6886
Mailing Address - Fax:
Practice Address - Street 1:22750 ROCKSIDE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-1574
Practice Address - Country:US
Practice Address - Phone:419-944-6886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care