1003934498 NPI number — VILLAGE OF GNADENHUTTEN

Table of content: (NPI 1003934498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003934498 NPI number — VILLAGE OF GNADENHUTTEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VILLAGE OF GNADENHUTTEN
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:
1003934498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 W 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44622-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-602-5180
Provider Business Mailing Address Fax Number:
330-602-5471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 N WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GNADENHUTTEN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44629-0155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-254-4307
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STULL
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CLERK
Authorized Official Telephone Number:
740-254-4307

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  79-201 , 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: 0337862 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: RR MEDICARE . This is a "9230021" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".