1760580211 NPI number — RONALD E ARRICK M D INC

Table of content: (NPI 1760580211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760580211 NPI number — RONALD E ARRICK M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD E ARRICK M D 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:
1760580211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1729 KINNEYS LANE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-354-8837
Provider Business Mailing Address Fax Number:
740-353-7943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 27TH ST STE 103 BLDG J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45662-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-354-8837
Provider Business Practice Location Address Fax Number:
740-353-7943
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARRICK
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MD PRESIDENT
Authorized Official Telephone Number:
740-354-8837

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35042736 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 34006652 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 09051NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2766458 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0429227 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110155403 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2020851 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 793111263 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".