1699782300 NPI number — SUSAN M HATFIELD PA

Table of content: SUSAN M HATFIELD PA (NPI 1699782300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699782300 NPI number — SUSAN M HATFIELD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATFIELD
Provider First Name:
SUSAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1699782300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1068 SEDGEFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAINEVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45039-7514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-722-5701
Provider Business Mailing Address Fax Number:
513-677-2404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1068 SEDGEFIELD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAINEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45039-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-722-5701
Provider Business Practice Location Address Fax Number:
513-677-2404
Provider Enumeration Date:
08/02/2006

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: 363AM0700X , with the licence number:  50.001572 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: PA1908 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA9102015 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 103502800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".