MID OHIO EMERGENCY PHYSICIANS LLP - NPI NUMBER 1548490790

Summary

Provider Name: MID OHIO EMERGENCY PHYSICIANS LLP

NPI Number: 1548490790

Clasification: Emergency Medicine (207P00000X)

Address:
335 GLESSNER AVE
MANSFIELD, OH
ZIP 44903

Phone Number: (419) 526-8000



Detailed Information

MID OHIO EMERGENCY PHYSICIANS LLP is an emergency physician in Mansfield, OH. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. The assigned NPI number for this provider is 1548490790 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

335 GLESSNER AVE
MANSFIELD, OH
ZIP 44903-269
Phone: (419) 526-8000
Fax: (419) 521-7690

The provider's authorized official is Derik K King .
The authorized official title is Llp Managing Partner and has the following contact phone number (866) 916-5259.

The enumeration date for this NPI number is 7/22/2009 and was last updated on 10/16/2009.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207P00000X Emergency Medicine Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 9384421 MEDICARE PIN OH
2 2964734 MEDICAID OH

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1548490790 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name MID OHIO EMERGENCY PHYSICIANS LLP The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 335 GLESSNER AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name MANSFIELD The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name OH The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 449032269 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 4195268000 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 4195217690 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 7/22/2009 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 10/16/2009 The date that a record was last updated or changed.
14 Authorized Official Last Name KING The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name DERIK The first name of the authorized official.
16 Authorized Official Middle Name K The middle name of the authorized official.
17 Authorized Official Title or Position LLP MANAGING PARTNER The title or position of the authorized official.
18 Authorized Official Telephone Number 8669165259 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 207P00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 9384421 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
22 Other Provider Identifier Type Code 1 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier State 1 OH
24 Other Provider Identifier 2 2964734 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier State 2 OH
27 Is Organization Subpart N
28 Authorized Official Name Prefix Text DR.
29 Authorized Official Credential Text MD
30 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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