1396861464 NPI number — MR. MICHAEL E FURDA P.T.

Table of content: MR. MICHAEL E FURDA P.T. (NPI 1396861464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396861464 NPI number — MR. MICHAEL E FURDA P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FURDA
Provider First Name:
MICHAEL
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1396861464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43953-3734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-266-6855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43953-3733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-266-6855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007

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: 225100000X , with the licence number:  PT004752 , 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: 699738 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 203267955 . This is a "TAX ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 536082 . This is a "INDIVIDUAL BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 536080 . This is a "GROUP BCBS NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2650108 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 732344 . This is a "HEALTH ASSURANCE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com