1508951484 NPI number — HEALTHQUEST OF AVON, INC.

Table of content: (NPI 1508951484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508951484 NPI number — HEALTHQUEST OF AVON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHQUEST OF AVON, 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:
1508951484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33560 DETROIT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44011-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-937-4222
Provider Business Mailing Address Fax Number:
440-967-8715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33560 DETROIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44011-2030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-937-4222
Provider Business Practice Location Address Fax Number:
440-967-8715
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAIN
Authorized Official First Name:
KRISTY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-937-4222

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2074 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 3492 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 3350 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: PT 06257 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 8647 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2443636 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA 7565 . This is a "RAILROAD MEDICARE GRP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2441656 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2537642 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".