1013168087 NPI number — NEUROLOGY ASSOCIATES OF SOUTHERN OHIO LLC

Table of content: (NPI 1013168087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013168087 NPI number — NEUROLOGY ASSOCIATES OF SOUTHERN OHIO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY ASSOCIATES OF SOUTHERN OHIO LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013168087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 CEREAL AVE
Provider Second Line Business Mailing Address:
SUITE 212
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45013-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-867-2560
Provider Business Mailing Address Fax Number:
513-737-3389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 CEREAL AVE
Provider Second Line Business Practice Location Address:
STE 212
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45013-2784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-867-2560
Provider Business Practice Location Address Fax Number:
513-737-3389
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MULLA OSSMANN
Authorized Official First Name:
OMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
513-867-2560

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100079810 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2916170 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO4383 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200948730 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200948730 B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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