1659515500 NPI number — VALERIE C FOUTS-FOWLER

Table of content: VALERIE C FOUTS-FOWLER (NPI 1659515500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659515500 NPI number — VALERIE C FOUTS-FOWLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOUTS-FOWLER
Provider First Name:
VALERIE
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1659515500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20800 HARVARD RD
Provider Second Line Business Mailing Address:
2ND FLR
Provider Business Mailing Address City Name:
HIGHLAND HILLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-7251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 CROCKER RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-6972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-871-5100
Provider Business Practice Location Address Fax Number:
440-871-5610
Provider Enumeration Date:
04/22/2009

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 34-010675 , 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)