1629577671 NPI number — TAMALA DARLENE BELLISH LSW S.1701440

Table of content: TAMALA DARLENE BELLISH LSW S.1701440 (NPI 1629577671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629577671 NPI number — TAMALA DARLENE BELLISH LSW S.1701440

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLISH
Provider First Name:
TAMALA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW S.1701440
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELLISH
Provider Other First Name:
TAMALA
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW S.1701440
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629577671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 SPRING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRUTHERS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-301-5040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRUTHERS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-330-3030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2018

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: 101Y00000X , with the licence number:  S.1701440 , 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)





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