1427249044 NPI number — MRS. EILEEN F BLINE LISW-S

Table of content: MRS. EILEEN F BLINE LISW-S (NPI 1427249044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427249044 NPI number — MRS. EILEEN F BLINE LISW-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLINE
Provider First Name:
EILEEN
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW-S
Provider Gender Code:
F

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:
1427249044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 OFFICENTER PL STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-5351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-664-3595
Provider Business Mailing Address Fax Number:
614-664-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 UNION ST STE B1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43055-3998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-349-7066
Provider Business Practice Location Address Fax Number:
740-345-6028
Provider Enumeration Date:
08/08/2007

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: 1041C0700X , with the licence number:  I-0008947 , 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: 10193 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31-0711374 . This is a "TAX ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1376607374 . This is a "ORGANIZATION NPI#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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