Provider Demographics
NPI:1881953297
Name:BEDFORD COMMUNITY EMERGENCY CENTER
Entity type:Organization
Organization Name:BEDFORD COMMUNITY EMERGENCY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-234-8833
Mailing Address - Street 1:22750 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1574
Mailing Address - Country:US
Mailing Address - Phone:440-439-0086
Mailing Address - Fax:
Practice Address - Street 1:22750 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-1574
Practice Address - Country:US
Practice Address - Phone:440-439-0086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QU0200X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty