1407834955 NPI number — PROFESSIONAL PRIMARY CARE SERVICES OF SOUTHERN OHIO

Table of content: (NPI 1407834955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407834955 NPI number — PROFESSIONAL PRIMARY CARE SERVICES OF SOUTHERN OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL PRIMARY CARE SERVICES OF SOUTHERN OHIO
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:
HILLSBORO URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1407834955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 951216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-777-6017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 ROBERTS LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45133-7608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-383-1040
Provider Business Practice Location Address Fax Number:
937-383-1380
Provider Enumeration Date:
01/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHOO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-383-1040

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332B00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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