1194834143 NPI number — WALTER WOLOSIANSKY

Table of content: (NPI 1194834143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194834143 NPI number — WALTER WOLOSIANSKY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALTER WOLOSIANSKY
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:
COMMUNITY HEARING SERVICES
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:
1194834143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 667
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44232-0667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-896-9119
Provider Business Mailing Address Fax Number:
330-896-1185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 MASSILLON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44720-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-896-9119
Provider Business Practice Location Address Fax Number:
330-896-1185
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOLOSIANSKY
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER AUDIOLOGIST
Authorized Official Telephone Number:
330-896-9119

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  A00655 , 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: 062466314001 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000136008 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7858279 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0793619 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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