Provider Demographics
NPI:1821189085
Name:MIAMI VALLEY EMERGENCY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:MIAMI VALLEY EMERGENCY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANGALANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-885-0002
Mailing Address - Street 1:PO BOX 951426
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0016
Mailing Address - Country:US
Mailing Address - Phone:513-281-4400
Mailing Address - Fax:513-587-8213
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:513-281-4400
Practice Address - Fax:513-587-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2181973Medicaid
OHMI9311021Medicare PIN