1144426529 NPI number — BAVARIA MEDDAC

Table of content: DR. RICHARD G. ELLSWORTH PHD (NPI 1598814964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144426529 NPI number — BAVARIA MEDDAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAVARIA MEDDAC
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:
USADC WUERZBURG
Provider Other Organization Name Type Code:
3
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:
1144426529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 402
Provider Second Line Business Mailing Address:
BLDG 3700 ERMC UBO
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
01149637194647400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 26610
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
01149637194647400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCLOUGHLIN
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH SYSTEMS SPEC
Authorized Official Telephone Number:
01149637194645471

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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