1497835292 NPI number — TIFFANY JANELLE WINCE MD

Table of content: RICHARD GLEINER L.C.S.W (NPI 1407093057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497835292 NPI number — TIFFANY JANELLE WINCE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINCE
Provider First Name:
TIFFANY
Provider Middle Name:
JANELLE
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:
1497835292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 449
Provider Second Line Business Mailing Address:
418 1/2 COLEGATE DRIVE
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45750-0449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-374-4500
Provider Business Mailing Address Fax Number:
740-374-5887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 MATTHEW ST
Provider Second Line Business Practice Location Address:
EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45750-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-374-1400
Provider Business Practice Location Address Fax Number:
740-374-1693
Provider Enumeration Date:
10/16/2006

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: 207P00000X , with the licence number:  1644-850 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 35120651 , 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: 0079316 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810025619 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01259806 . This is a "RAILROAD MEDICARE - MHCPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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