1477441681 NPI number — WORTHAM & FLORENCE ENTERPRISES

Table of content: (NPI 1477441681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477441681 NPI number — WORTHAM & FLORENCE ENTERPRISES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORTHAM & FLORENCE ENTERPRISES
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:
1477441681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6545 MARKET AVE N STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44721-2430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-321-0002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 CLARETT CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45322-3545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-321-0002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
WORTHAM-FLORENCE
Authorized Official First Name:
ROOSEVELT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
937-321-0002

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com