Provider Demographics
NPI:1699732032
Name:ELLWOOD EMERGENCY PHYSICIANS INC
Entity type:Organization
Organization Name:ELLWOOD EMERGENCY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-668-6491
Mailing Address - Street 1:PO BOX 951806
Mailing Address - Street 2:ELLWOOD EMERGENCY PHYSICIANS INC
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0020
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-660-9384
Practice Address - Street 1:724 PERSHING STREET
Practice Address - Street 2:ELLWOOD CITY HOSPITAL
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117
Practice Address - Country:US
Practice Address - Phone:724-752-6744
Practice Address - Fax:610-617-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA622497Medicare ID - Type Unspecified