1811286214 NPI number — ASHLEY N GRINONNEAU DENTON PCC

Table of content: ASHLEY N GRINONNEAU DENTON PCC (NPI 1811286214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811286214 NPI number — ASHLEY N GRINONNEAU DENTON PCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRINONNEAU DENTON
Provider First Name:
ASHLEY
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PCC
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:
1811286214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24800 HIGHPOINT RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-6052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-831-6611
Provider Business Mailing Address Fax Number:
216-831-2726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24800 HIGHPOINT RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-831-6611
Provider Business Practice Location Address Fax Number:
216-831-2726
Provider Enumeration Date:
04/06/2011

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: 101YP2500X , with the licence number:  E.0700483 , 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)





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