1477702603 NPI number — MEDICAL SERVICES OF COSHOCTON, INC

Table of content: (NPI 1477702603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477702603 NPI number — MEDICAL SERVICES OF COSHOCTON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL SERVICES OF COSHOCTON, 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:
PLEASANT VALLEY DOCTOR'S CLINIC
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:
1477702603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LAFAYETTE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43845-0057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 PLEASANT VALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812-9137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-295-5922
Provider Business Practice Location Address Fax Number:
740-295-5927
Provider Enumeration Date:
09/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
K
Authorized Official Title or Position:
SENIOR DIRECTOR
Authorized Official Telephone Number:
740-623-4370

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35092289 , 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)





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