1073523874 NPI number — JULIE A CIANCHETTI-BRIDGEFORD C.N.P.

Table of content: JULIE A CIANCHETTI-BRIDGEFORD C.N.P. (NPI 1073523874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073523874 NPI number — JULIE A CIANCHETTI-BRIDGEFORD C.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIANCHETTI-BRIDGEFORD
Provider First Name:
JULIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.N.P.
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:
1073523874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HIGH ST FL 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45011-6078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-454-1460
Provider Business Mailing Address Fax Number:
937-223-9811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 NW WASHINGTON BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45013-6367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-454-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2006

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:  NP06470 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: NP06470 , 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: 2318503 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2040759 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2103600 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2108221 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063482 . This is a "WORKERS COMP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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