1396926648 NPI number — MRS. ELIZABETH ELAINE PEACH MS, CGC

Table of content: MRS. ELIZABETH ELAINE PEACH MS, CGC (NPI 1396926648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396926648 NPI number — MRS. ELIZABETH ELAINE PEACH MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEACH
Provider First Name:
ELIZABETH
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396926648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BURNET AVE
Provider Second Line Business Mailing Address:
ML 11020 FETAL CARE CENTER
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45229-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-636-6289
Provider Business Mailing Address Fax Number:
513-636-5959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 BURNET AVE
Provider Second Line Business Practice Location Address:
ML 11020 FETAL CARE CENTER
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45229-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-636-6289
Provider Business Practice Location Address Fax Number:
513-636-5959
Provider Enumeration Date:
11/15/2007

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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