1073652780 NPI number — SHARON A GRIFFITH CRNA

Table of content: SHARON A GRIFFITH CRNA (NPI 1073652780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073652780 NPI number — SHARON A GRIFFITH CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFITH
Provider First Name:
SHARON
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

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:
1073652780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 868
Provider Second Line Business Mailing Address:
807 W MAIN ST
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45177-0868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-382-1864
Provider Business Mailing Address Fax Number:
937-382-8917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45177-0868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-382-1864
Provider Business Practice Location Address Fax Number:
937-382-8917
Provider Enumeration Date:
02/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  044724 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000074858 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0932692 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".