1144779679 NPI number — SOUTHERN OHIO INTEGRATED SERVICES, LLC

Table of content: (NPI 1144779679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144779679 NPI number — SOUTHERN OHIO INTEGRATED SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN OHIO INTEGRATED SERVICES, LLC
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:
1144779679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3290 MUSGROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45176-9151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-582-1069
Provider Business Mailing Address Fax Number:
937-444-0044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 DAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT ORAB
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45154-8924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-444-0044
Provider Business Practice Location Address Fax Number:
937-444-0048
Provider Enumeration Date:
09/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BOGGS
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-582-1069

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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