1689925356 NPI number — HEALTH PARTNERS OF WESTERN OHIO

Table of content: (NPI 1689925356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689925356 NPI number — HEALTH PARTNERS OF WESTERN OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH PARTNERS OF WESTERN OHIO
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:
KENTON COMMUNITY HEALTH CENTER PHARMACY
Provider Other Organization Name Type Code:
3
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:
1689925356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 W ESPY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43326-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-679-5995
Provider Business Mailing Address Fax Number:
419-679-1393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 W ESPY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43326-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-679-5995
Provider Business Practice Location Address Fax Number:
419-679-1393
Provider Enumeration Date:
09/21/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHARMACY SERVICES
Authorized Official Telephone Number:
419-222-1680

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 022241650 , 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: 2137048 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0072656 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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