1649447582 NPI number — WRIGHT STATE PHYSICIANS INC

Table of content: (NPI 1649447582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649447582 NPI number — WRIGHT STATE PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRIGHT STATE PHYSICIANS 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:
UNIVERISTY MEDICAL SERVICES ASSOCIATION
Provider Other Organization Name Type Code:
4
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:
1649447582
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45435-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-245-7100
Provider Business Mailing Address Fax Number:
937-245-7999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 PHILADELPHIA DR
Provider Second Line Business Practice Location Address:
SUITE 651
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45406-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-208-3999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SAVAKINAS
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
937-245-7150

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  821388 , 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: WR9256604 . This is a "PARENT LBN MEDICARE GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1114920329 . This is a "PARENT NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1295977254 . This is a "DME-SUBGROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0914443 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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