1538381439 NPI number — MRS. PAULA DAVIS FULTZ P.C.C.-.S,R.D.,L.D.

Table of content: MRS. PAULA DAVIS FULTZ P.C.C.-.S,R.D.,L.D. (NPI 1538381439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538381439 NPI number — MRS. PAULA DAVIS FULTZ P.C.C.-.S,R.D.,L.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FULTZ
Provider First Name:
PAULA
Provider Middle Name:
DAVIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.C.C.-.S,R.D.,L.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FULTZ
Provider Other First Name:
PAULA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.C.C.-S.,R.D.,L.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538381439
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:
10509 KINGS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N. ROYALTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44133-1970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-582-3744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 E. BAGLEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEREA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-260-8375
Provider Business Practice Location Address Fax Number:
440-260-8390
Provider Enumeration Date:
05/02/2007

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: 101YM0800X , with the licence number:  E0003210SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 133V00000X , with the licence number: LD861 , 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)