Provider Demographics
NPI:1396722641
Name:NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC
Entity type:Organization
Organization Name:NEW CENTURY EMERGENCY PHYSICIAN OF WEST VIRGINIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-726-3627
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:
Practice Address - Street 1:800 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3351
Practice Address - Country:US
Practice Address - Phone:304-388-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV363L00000X, 363A00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001769857OtherWV BCBS (PA)
WV001965204OtherBLUE CROSS BLUE SHIELD
WV0203138000Medicaid
OH3048964Medicaid
WV001709240OtherWV BCBS (NP)
WV001709239OtherWV BCBS (MD DO)
WV0203048000Medicaid
WV001965433OtherBLUE CROSS BLUE SHIELD
WV150778001OtherDEPARTMENT OF LABOR
WV001965430OtherBLUE CROSS BLUE SHIELD
OH3048964Medicaid
WV001965204OtherBLUE CROSS BLUE SHIELD
WV001965433OtherBLUE CROSS BLUE SHIELD
WV001965433OtherBLUE CROSS BLUE SHIELD
WV0203048000Medicaid
WVNE9311363Medicare ID - Type Unspecified