1275909848 NPI number — MR. ABUNGEH LUAH NIBAH CFR, 8HR DODD CERTIF

Table of content: MR. ABUNGEH LUAH NIBAH CFR, 8HR DODD CERTIF (NPI 1275909848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275909848 NPI number — MR. ABUNGEH LUAH NIBAH CFR, 8HR DODD CERTIF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIBAH
Provider First Name:
ABUNGEH
Provider Middle Name:
LUAH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CFR, 8HR DODD CERTIF
Provider Gender Code:
M

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:
1275909848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 JOYCE LANE, APT #4,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-680-9216
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 JOYCE LANE, APT #4,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-680-9216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3117326 . This is a "CONTRACT NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0074062 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".