1376879221 NPI number — MVHE INC

Table of content: (NPI 1376879221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376879221 NPI number — MVHE INC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
MVHE 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:
EDUCARE FAMILY MEDICINE
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:
1376879221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1685 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
SPRINGBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45066-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-748-2858
Provider Business Mailing Address Fax Number:
937-748-2896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1685 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
SPRINGBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45066-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-748-2858
Provider Business Practice Location Address Fax Number:
937-748-2896
Provider Enumeration Date:
10/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRUNIER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
937-208-8213

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2068024 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".