1255608519 NPI number — OHIO UNIVERSITY

Table of content: (NPI 1255608519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255608519 NPI number — OHIO UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO UNIVERSITY
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:
OHIO UNIVERSITY THERAPY ASSOCIATES
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:
1255608519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W174 GROVER CENTER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-593-1404
Provider Business Mailing Address Fax Number:
740-593-4433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W174 GROVER CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-593-1404
Provider Business Practice Location Address Fax Number:
740-593-4433
Provider Enumeration Date:
11/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MALAWISTA
Authorized Official First Name:
MARIANNE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
COORDINATOR OF CLINICAL SERVICES
Authorized Official Telephone Number:
740-593-1418

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  A01437 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X , with the licence number: A01437 , 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: 0058187 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000246469 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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