1487602769 NPI number — SCOTT D GILLETTE CRNA

Table of content: SCOTT D GILLETTE CRNA (NPI 1487602769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487602769 NPI number — SCOTT D GILLETTE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLETTE
Provider First Name:
SCOTT
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1487602769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44309-2090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-375-3765
Provider Business Mailing Address Fax Number:
330-375-7586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-375-3765
Provider Business Practice Location Address Fax Number:
330-375-7586
Provider Enumeration Date:
05/05/2006

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: 367500000X , with the licence number:  157695 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: RN-256368 , 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: 2080224 . This is a "UNITED HEALTHCARE GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2541084 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100153 . This is a "EMPLOYER KAISER GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34-0891295 . This is a "EMPLOYER FEDERAL TAX ID #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000357686 . This is a "ANTHEM BCBS INDV NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7091249 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 730554 . This is a "BUCKEYE COMMUNITY HLTH PL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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