1487659066 NPI number — CARLA M KREBS MD

Table of content: CARLA M KREBS MD (NPI 1487659066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487659066 NPI number — CARLA M KREBS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREBS
Provider First Name:
CARLA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1487659066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21375 LORAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRVIEW PARK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44126-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-333-7346
Provider Business Mailing Address Fax Number:
440-333-0273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21375 LORAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRVIEW PARK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44126-2122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-333-7346
Provider Business Practice Location Address Fax Number:
440-333-0273
Provider Enumeration Date:
06/20/2005

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: 207W00000X , with the licence number:  066584 , 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: 341311807 . This is a "TAX ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000028180 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0826931 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1487659066 . This is a "NPI NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 08-01177 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1164492591 . This is a "PRACTICE LOCATION LAKEWOOD NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1275512709 . This is a "MEDICARE PRACTICE NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 180020032 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0004501425 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: F66584 . This is a "APEX" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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