1528245479 NPI number — PURA G VARGAS MD INC

Table of content: (NPI 1528245479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528245479 NPI number — PURA G VARGAS MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PURA G VARGAS MD INC
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:
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:
1528245479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 EXECUTIVE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-668-8881
Provider Business Mailing Address Fax Number:
419-668-0668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 EXECUTIVE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-668-8881
Provider Business Practice Location Address Fax Number:
419-668-0668
Provider Enumeration Date:
01/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VARGAS
Authorized Official First Name:
PURA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
419-668-8881

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  35032040 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 35032040 , 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: 0144356 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000128808 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 024328291001 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".