1164480851 NPI number — NOEL N EBOH MD

Table of content: NOEL N EBOH MD (NPI 1164480851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164480851 NPI number — NOEL N EBOH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EBOH
Provider First Name:
NOEL
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1164480851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
# L-3549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43260-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-383-7927
Provider Business Mailing Address Fax Number:
740-383-7942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 DELAWARE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43301-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-383-7950
Provider Business Practice Location Address Fax Number:
740-383-7087
Provider Enumeration Date:
05/02/2006

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: 207T00000X , with the licence number:  35044038E , 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: 0410657 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140004259 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311098079 . This is a "PPO NEXT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0465301 . This is a "PALMETTO MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 353077 . This is a "SUBMITTER NO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311098079069 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0600018 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311098079 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311098079 . This is a "TAXID E" identifier . This identifiers is of the category "OTHER".
  • Identifier: 646717 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000118446 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311098079 . This is a "TAX ID PHYSICIANS NONPHYS" identifier . This identifiers is of the category "OTHER".




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