1760497333 NPI number — MAUMEE INTERNISTS, INC.

Table of content: (NPI 1760497333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760497333 NPI number — MAUMEE INTERNISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAUMEE INTERNISTS, INC.
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:
1760497333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7550 LUCERNE DR
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
MIDDLEBURG HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-6588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-893-3306
Provider Business Mailing Address Fax Number:
419-893-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 MONCLOVA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43537-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-893-3306
Provider Business Practice Location Address Fax Number:
419-893-2274
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHWISOW
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PROVIDER/SENIOR PARTNER
Authorized Official Telephone Number:
419-893-3306

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0371048 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".