1689835415 NPI number — SPECIALTY PHYSICIANS OF BLANCHARD VALLEY LLC

Table of content: (NPI 1689835415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689835415 NPI number — SPECIALTY PHYSICIANS OF BLANCHARD VALLEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALTY PHYSICIANS OF BLANCHARD VALLEY 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:
1689835415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FINDLAY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45840-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-423-5370
Provider Business Mailing Address Fax Number:
419-423-5292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FINDLAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45840-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-423-4500
Provider Business Practice Location Address Fax Number:
419-423-5358
Provider Enumeration Date:
06/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CYTLAK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE
Authorized Official Telephone Number:
419-423-5497

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6451 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: 35063285 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 35099817 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 35125243 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 35074063 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 35123397 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2853130 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DN8267 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".