1629479639 NPI number — GUPTA PSYCHIATRIC SERVICES LLC

Table of content: (NPI 1629479639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629479639 NPI number — GUPTA PSYCHIATRIC SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUPTA PSYCHIATRIC SERVICES LLC
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:
1629479639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 706346
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45270-6346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-421-4099
Provider Business Mailing Address Fax Number:
513-347-2116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3260 WESTBOURNE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45248-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-421-4099
Provider Business Practice Location Address Fax Number:
513-347-2116
Provider Enumeration Date:
09/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GUPTA
Authorized Official First Name:
BABU
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-421-4099

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X , with the licence number:  35066574 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X , with the licence number: 29831 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com