1023094091 NPI number — DR. AMY M BYERLY DO

Table of content: DR. AMY M BYERLY DO (NPI 1023094091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023094091 NPI number — DR. AMY M BYERLY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYERLY
Provider First Name:
AMY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
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:
1023094091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7740 WASHNGTON VLG DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45459-4056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-531-7900
Provider Business Mailing Address Fax Number:
937-531-7901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7740 WASHINGTON VILLAGE DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459-3953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-531-7900
Provider Business Practice Location Address Fax Number:
937-531-7901
Provider Enumeration Date:
12/21/2005

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: 207V00000X , with the licence number:  34007414 , 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: 000000290784 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 421534506070 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0704300 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7700448 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2205492 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000290784 . This is a "UNICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34007414B . This is a "MEDICAL LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00047033 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: D0741402 . This is a "HUMANA/CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: D0741403 . This is a "HUMANA/CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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