1124686332 NPI number — MRS. KARI MARIE MUMAW

Table of content: MRS. KARI MARIE MUMAW (NPI 1124686332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124686332 NPI number — MRS. KARI MARIE MUMAW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUMAW
Provider First Name:
KARI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAUMGARTNER
Provider Other First Name:
KARI
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124686332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/22/2020
NPI Reactivation Date:
07/01/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 CAMERON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-4101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-874-6789
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 CAMERON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45246-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-874-6789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2019

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-19-38849 , 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)