1013953942 NPI number — DENNIS J. PIERSON, M.D., INC.

Table of content: (NPI 1013953942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013953942 NPI number — DENNIS J. PIERSON, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENNIS J. PIERSON, 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:
PIERSON FAMILY PRACTICE
Provider Other Organization Name Type Code:
5
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:
1013953942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 E ELM ST
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45804-2898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-227-9676
Provider Business Mailing Address Fax Number:
419-227-9794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 E ELM ST
Provider Second Line Business Practice Location Address:
STE 240
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45804-2898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-227-9676
Provider Business Practice Location Address Fax Number:
419-227-9794
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PIERSON
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-227-9676

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35-043987P , 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: 735029 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2174105 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5641551 . This is a "AETNA HMO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0636167 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CG1874 . This is a "RAILROAD MEDICARE-PALMETT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000031107 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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