1679029318 NPI number — HEALTH EXPERIENCES

Table of content: (NPI 1679029318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679029318 NPI number — HEALTH EXPERIENCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH EXPERIENCES
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:
1679029318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 WILLIAM HOWARD TAFT RD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45219-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-616-8774
Provider Business Mailing Address Fax Number:
513-861-0105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 WILLIAM HOWARD TAFT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-616-8774
Provider Business Practice Location Address Fax Number:
513-861-0105
Provider Enumeration Date:
09/01/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
513-616-8774

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  0000146 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: CDCA 140008 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: CDCA 140335 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: CDCA 130975 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: LCDC 991775.3 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 0006084 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WA0400X , with the licence number: RN294057 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: PN131023 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 35.072050 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35076827 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084A0401X , with the licence number: 35039200 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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