1699016782 NPI number — ATHLETIC MEDICAL SOLUTIONS LLC

Table of content: KHOA MINH DOAN (NPI 1619490687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699016782 NPI number — ATHLETIC MEDICAL SOLUTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHLETIC MEDICAL SOLUTIONS LLC
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:
BUCKEYE PHYSICAL MEDICINE AND REHAB., LLC
Provider Other Organization Name Type Code:
3
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:
1699016782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2222 STRINGTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROVE CITY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43123-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-871-2273
Provider Business Mailing Address Fax Number:
614-871-3324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2222 STRINGTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GROVE CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-277-1248
Provider Business Practice Location Address Fax Number:
614-801-9095
Provider Enumeration Date:
03/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNEID
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
614-305-5062

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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