1790765386 NPI number — KIMBERLY C SHEETS DO

Table of content: KIMBERLY C SHEETS DO (NPI 1790765386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790765386 NPI number — KIMBERLY C SHEETS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEETS
Provider First Name:
KIMBERLY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1790765386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 ELYRIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44254-1031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-948-5533
Provider Business Mailing Address Fax Number:
330-948-2726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 ELYRIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-948-9939
Provider Business Practice Location Address Fax Number:
330-948-2263
Provider Enumeration Date:
01/19/2006

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: 207Q00000X , with the licence number:  34-008209 , 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: 1801807870 . This is a "LODI HOSPITAL TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1003849910 . This is a "LODI COMMUNITY CARE CENTER TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2396081 . This is a "LODI HOSPITAL MEDICAID #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3613031 . This is a "LODI HOSPITAL MEDICARE #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2504909 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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