1164646329 NPI number — PATRICK DAWSON LLC

Table of content: MARK F HYNDMAN M.D. (NPI 1992795249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164646329 NPI number — PATRICK DAWSON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK DAWSON 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:
THE EYE SITE OF SPRINGFIELD
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:
1164646329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1674 N LIMESTONE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-399-4101
Provider Business Mailing Address Fax Number:
937-399-2346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1674 N LIMESTONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-399-4101
Provider Business Practice Location Address Fax Number:
937-399-2346
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-399-4101

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4831 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 2961 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 4550 , 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: 4550 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 029665 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0995240 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2478993 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: T1293 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: T617 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4831 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2260655 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2961 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: T1696 . This is a "LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com