1053591321 NPI number — DR. MARK S. MASSIE, L.L.C.

Table of content: DR. REBECCA SMUTZER HUSER DDS (NPI 1275691156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053591321 NPI number — DR. MARK S. MASSIE, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. MARK S. MASSIE, L.L.C.
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:
1053591321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44140-0450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-871-4700
Provider Business Mailing Address Fax Number:
440-871-4702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15644 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44107-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-221-2445
Provider Business Practice Location Address Fax Number:
216-221-5891
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASSIE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
216-221-2445

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  3074 , 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: 2876351 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE5695 . This is a "MEDICARE RAILROAD GROUP PIN NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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