Provider Demographics
NPI:1700872728
Name:QUALIFIED EMERGENCY SPECIALISTS INC
Entity Type:Organization
Organization Name:QUALIFIED EMERGENCY SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-865-9040
Mailing Address - Street 1:10506 MONTGOMERY RD
Mailing Address - Street 2:SUITE #209
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4487
Mailing Address - Country:US
Mailing Address - Phone:513-865-1307
Mailing Address - Fax:
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-1307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0866273Medicaid
IN100020100AMedicaid
IN100020100CMedicaid
IN100020100BMedicaid
IN100020100EMedicaid
OH2400002Medicaid
OH0850306Medicaid
IN100020100DMedicaid
IN100020100FMedicaid
IN100020100HMedicaid
OH0809807Medicaid
KY65930737Medicaid
OH0765391Medicaid
IN100020100IMedicaid
OH2049545Medicaid
OH2400020Medicaid
OH2049545Medicaid
OHCA7808Medicare PIN