1245256817 NPI number — PHYSIOSOURCE LTD.

Table of content: (NPI 1245256817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245256817 NPI number — PHYSIOSOURCE LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIOSOURCE LTD.
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:
1245256817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 878
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVANIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43560-0878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-724-5580
Provider Business Mailing Address Fax Number:
419-724-5581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3840 WOODLEY RD.
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-1178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-724-5580
Provider Business Practice Location Address Fax Number:
419-724-5581
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHERMAN
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
419-724-5580

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT07759 , 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: 000000285765 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2419743 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD2140 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 731071 . This is a "BUCKEYE COMMUNITY HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 498394182 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 362488800 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com