1679605406 NPI number — DR. KAREN B MURRAY OD

Table of content: DR. KAREN B MURRAY OD (NPI 1679605406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679605406 NPI number — DR. KAREN B MURRAY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
KAREN
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

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:
1679605406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6175 SOM CENTER RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SOLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44139-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-248-3900
Provider Business Mailing Address Fax Number:
440-248-3479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6175 SOM CENTER RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SOLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44139-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-248-3900
Provider Business Practice Location Address Fax Number:
440-248-3479
Provider Enumeration Date:
03/09/2007

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: 152WC0802X , with the licence number:  3924 , 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: 34-1782789 . This is a "TAX ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000138603 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34-1782789-008 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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