1194875245 NPI number — DR. ROBERT B SHEELY D.C.

Table of content: DR. ROBERT B SHEELY D.C. (NPI 1194875245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194875245 NPI number — DR. ROBERT B SHEELY D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEELY
Provider First Name:
ROBERT
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1194875245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 N UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45042-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-217-7035
Provider Business Mailing Address Fax Number:
513-318-4973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 N UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45042-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-217-7035
Provider Business Practice Location Address Fax Number:
513-318-4973
Provider Enumeration Date:
01/11/2007

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: 111N00000X , with the licence number:  841 , 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: 000000010589 . This is a "ANTHEM ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0841C01 . This is a "HUMANA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311021750026 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: L0437085 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31-1021750 . This is a "TAX ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com