1073782983 NPI number — C A CAHALL MD, INC

Table of content: (NPI 1073782983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073782983 NPI number — C A CAHALL MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C A CAHALL MD, 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:
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:
1073782983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W SIXTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LIVERPOOL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43920-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-385-9509
Provider Business Mailing Address Fax Number:
330-385-1008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 FOX LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26034-1599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-387-3344
Provider Business Practice Location Address Fax Number:
304-387-3006
Provider Enumeration Date:
02/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAHALL
Authorized Official First Name:
CLEMENT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-385-9509

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35081145 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: RN215713 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C9373081 . This is a "MEDICARE GROUP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".