1902046261 NPI number — PATRICIA HAYNES MD

Table of content: PATRICIA HAYNES MD (NPI 1902046261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902046261 NPI number — PATRICIA HAYNES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYNES
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1902046261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 DUPONT CIR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45150-2793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-576-7700
Provider Business Mailing Address Fax Number:
513-576-1020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1108 NORTHVIEW DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45133-1184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-393-5781
Provider Business Practice Location Address Fax Number:
937-393-5784
Provider Enumeration Date:
02/26/2009

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:  35095089 , 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: 2224772 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: H144670 . This is a "MEDICAIRE PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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