1346301694 NPI number — TREMAINE B. OATMAN, D.P.M., INC.

Table of content: (NPI 1346301694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346301694 NPI number — TREMAINE B. OATMAN, D.P.M., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREMAINE B. OATMAN, D.P.M., INC.
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:
1346301694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7665 MENTOR AVE
Provider Second Line Business Mailing Address:
#347
Provider Business Mailing Address City Name:
MENTOR
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44060-5409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-974-1775
Provider Business Mailing Address Fax Number:
440-974-9572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8250 WINTHROP CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-5949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-974-1775
Provider Business Practice Location Address Fax Number:
440-974-9572
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OATMAN
Authorized Official First Name:
TREMAINE
Authorized Official Middle Name:
BOOTH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-974-1775

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36.001994 , 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: 000120549 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: DF4324 . This is a "PALMETTO GBA RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000133008 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: C 0490622 . This is a "UNITED AMERICAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000120549 . This is a "MOUNTAIN STATE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2857305 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com