1518131531 NPI number — 24 ON PHYSICIANS, P.C.

Table of content: (NPI 1518131531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518131531 NPI number — 24 ON PHYSICIANS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
24 ON PHYSICIANS, P.C.
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:
1518131531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 403631
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-3631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-740-0895
Provider Business Mailing Address Fax Number:
770-740-0896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
561 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAWARE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43015-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-368-5633
Provider Business Practice Location Address Fax Number:
740-368-4484
Provider Enumeration Date:
04/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FULLER
Authorized Official First Name:
DAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
770-740-0895

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2655390 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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