Provider Demographics
NPI:1952340812
Name:NORTHEAST OHIO EMERGENCY AFFILIATES
Entity Type:Organization
Organization Name:NORTHEAST OHIO EMERGENCY AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-331-9520
Mailing Address - Street 1:4700 ROCKSIDE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2155
Mailing Address - Country:US
Mailing Address - Phone:216-643-3000
Mailing Address - Fax:216-643-3011
Practice Address - Street 1:2639 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2911
Practice Address - Country:US
Practice Address - Phone:440-331-9520
Practice Address - Fax:440-331-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID
OHNO9276451Medicare ID - Type UnspecifiedMEDICARE