1437233996 NPI number — MR. THOMAS HAROLD COSS LISW

Table of content: MR. THOMAS HAROLD COSS LISW (NPI 1437233996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437233996 NPI number — MR. THOMAS HAROLD COSS LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COSS
Provider First Name:
THOMAS
Provider Middle Name:
HAROLD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LISW
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:
1437233996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4644 ANDERSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH EUCLID
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44121-3805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-291-0570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 S STATE ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
PAINESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44077-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-357-6740
Provider Business Practice Location Address Fax Number:
440-350-0506
Provider Enumeration Date:
10/24/2006

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: 1041C0700X , with the licence number:  I .0000144 , 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)





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