1346419066 NPI number — STATE ROAD OCCUPATIONAL MEDICAL FACILITY LLC

Table of content: LINDSEY M. BECKHAM CRNP (NPI 1023409091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346419066 NPI number — STATE ROAD OCCUPATIONAL MEDICAL FACILITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE ROAD OCCUPATIONAL MEDICAL FACILITY 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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1346419066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 STATE RD
Provider Second Line Business Mailing Address:
SUITE 166
Provider Business Mailing Address City Name:
ASHTABULA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44004-3933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-992-9521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 STATE RD
Provider Second Line Business Practice Location Address:
SUITE 166
Provider Business Practice Location Address City Name:
ASHTABULA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44004-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-992-9521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCVOY
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
440-992-9521

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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