1306171913 NPI number — RAPHAEL HEALTH CARE, LLC

Table of content: (NPI 1306171913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306171913 NPI number — RAPHAEL HEALTH CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAPHAEL HEALTH CARE, LLC
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:
RAPHAEL HEALTH CARE CLINIC
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:
1306171913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6631 COMMERCE PKWY
Provider Second Line Business Mailing Address:
SUITE Q
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-932-7000
Provider Business Mailing Address Fax Number:
614-932-7011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6631 COMMERCE PKWY
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43017-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-932-7000
Provider Business Practice Location Address Fax Number:
614-932-7011
Provider Enumeration Date:
10/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
MYUNGSOOK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-932-7000

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  35.092833 , 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: 35.092833 . This is a "OHIO MEDICAL BOARD LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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