1497705669 NPI number — INFECTIOUS DISEASES ASSOCIATES OF NW OHIO, INC.

Table of content: (NPI 1497705669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497705669 NPI number — INFECTIOUS DISEASES ASSOCIATES OF NW OHIO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFECTIOUS DISEASES ASSOCIATES OF NW OHIO, 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:
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:
1497705669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 CHERRY ST
Provider Second Line Business Mailing Address:
STE 1400
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43608-2673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-251-4787
Provider Business Mailing Address Fax Number:
419-251-6785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 CHERRY ST
Provider Second Line Business Practice Location Address:
STE 1400
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43608-2673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-251-4787
Provider Business Practice Location Address Fax Number:
419-251-6785
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAUREGUI
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-251-4787

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CC3611 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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