1396891495 NPI number — NATIONAL BIOLOGICAL CORPORATION

Table of content: (NPI 1396891495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396891495 NPI number — NATIONAL BIOLOGICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL BIOLOGICAL CORPORATION
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396891495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23700 MERCANTILE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-831-0600
Provider Business Mailing Address Fax Number:
216-765-0271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23700 MERCANTILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-831-0600
Provider Business Practice Location Address Fax Number:
216-765-0271
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
HALEY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
216-831-0600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X , with the licence number: 18501214 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0717673 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015850730002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100099785 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0731079 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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