1043622905 NPI number — AMY BETH FIRRELL NURSE PRACTITIONER

Table of content: AMY BETH FIRRELL NURSE PRACTITIONER (NPI 1043622905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043622905 NPI number — AMY BETH FIRRELL NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIRRELL
Provider First Name:
AMY
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEGERY
Provider Other First Name:
AMY
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043622905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20050 HARVARD ROAD SUITE 106
Provider Second Line Business Mailing Address:
SOUTH POINTE HOSPITAL
Provider Business Mailing Address City Name:
WARRENSVILLE HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-491-7036
Provider Business Mailing Address Fax Number:
216-491-7776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20050 HARVARD ROAD SUITE 106
Provider Second Line Business Practice Location Address:
SOUTH POINTE HOSPITAL
Provider Business Practice Location Address City Name:
WARRENSVILLE HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-491-7036
Provider Business Practice Location Address Fax Number:
216-491-7776
Provider Enumeration Date:
05/27/2014

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: 363LP2300X , with the licence number:  15802-NP , 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: 0159458 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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