1609941392 NPI number — BERISLAV SPAHIJA,M.D., INC.

Table of content: (NPI 1609941392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609941392 NPI number — BERISLAV SPAHIJA,M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERISLAV SPAHIJA,M.D., 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:
1609941392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16687 SAINT CLAIR AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
EAST LIVERPOOL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43920-9401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-382-1070
Provider Business Mailing Address Fax Number:
330-382-0916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16687 SAINT CLAIR AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
EAST LIVERPOOL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43920-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-382-1070
Provider Business Practice Location Address Fax Number:
330-382-0916
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPAHIJA
Authorized Official First Name:
BERISLAV
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-382-1070

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  3580889 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 35077285 , 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: 0500696 . This is a "UNTED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 218165 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130021621 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18076961300 . This is a "MMOH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 774691 . This is a "BS PA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000142099 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1047518 . This is a "WV COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2150390 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26386 . This is a "INDIANA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P77285 . This is a "HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000520339 . This is a "BC BS PA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95840 . This is a "QUALCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2260699 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6120037-000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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