1497853287 NPI number — ROLAND J AMASH D.C.

Table of content: ROLAND J AMASH D.C. (NPI 1497853287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497853287 NPI number — ROLAND J AMASH D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMASH
Provider First Name:
ROLAND
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1497853287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6725 STATE ROUTE 60
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45744-7307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-373-8222
Provider Business Mailing Address Fax Number:
740-373-8297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6725 STATE ROUTE 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45744-7307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-373-8222
Provider Business Practice Location Address Fax Number:
740-373-8297
Provider Enumeration Date:
09/20/2006

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: 111N00000X , with the licence number:  1886 , 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: 0919475 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4666465 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4900519-004 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000120475 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com