1639131501 NPI number — FRANK D TICE IV M.D.

Table of content: FRANK D TICE IV M.D. (NPI 1639131501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639131501 NPI number — FRANK D TICE IV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TICE
Provider First Name:
FRANK
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
IV
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1639131501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2570 ABINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER ARLINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43221-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-486-7165
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
745 W STATE ST
Provider Second Line Business Practice Location Address:
STE 750
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43222-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-224-2281
Provider Business Practice Location Address Fax Number:
614-221-8869
Provider Enumeration Date:
04/05/2006

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: 207RC0000X , with the licence number:  35056291T , 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: 2500396 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000000014654 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060038976 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10600 . This is a "NATIONWIDE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 289254 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9721935 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0761126 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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