1114128311 NPI number — DR. ERIC PAUL HAUS D.O.

Table of content: (NPI 1265569966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114128311 NPI number — DR. ERIC PAUL HAUS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAUS
Provider First Name:
ERIC
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1114128311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 N COLUMBUS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTLINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44827-1455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-468-0522
Provider Business Mailing Address Fax Number:
419-462-4599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2293 VILLAGE PARK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44906-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-747-3400
Provider Business Practice Location Address Fax Number:
419-747-3408
Provider Enumeration Date:
05/29/2007

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: 207R00000X , with the licence number:  34-00-7370 , 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: 2177817 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: H265920 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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