1265454144 NPI number — OPTI BILL, INC.

Table of content: (NPI 1265454144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265454144 NPI number — OPTI BILL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTI BILL, INC.
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:
OPTIMUM MEDICAL SOLUTIONS
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:
1265454144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24950 COUNTRY CLUB BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
NORTH OLMSTED
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44070-5342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-359-8704
Provider Business Mailing Address Fax Number:
440-359-8744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24950 COUNTRY CLUB BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
NORTH OLMSTED
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44070-5342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-359-8704
Provider Business Practice Location Address Fax Number:
440-359-8744
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLERIDGE
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-704-1770

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0827207 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0603980001 , issued by the state of ( OH ) . This identifiers is of the category "MEDICARE NSC".