1699829788 NPI number — NORTHCOAST INFUSION THERAPIES LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699829788 NPI number — NORTHCOAST INFUSION THERAPIES LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHCOAST INFUSION THERAPIES LTD.
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:
1699829788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7710 FIRST PL
Provider Second Line Business Mailing Address:
BLDG E, SUITE H
Provider Business Mailing Address City Name:
OAKWOOD VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44146-6717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-735-7150
Provider Business Mailing Address Fax Number:
440-735-7155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 WEST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TALLMADGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44278-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-735-7150
Provider Business Practice Location Address Fax Number:
440-735-7155
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPEIDEL
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
440-735-7150

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  02-100200 , 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: 2007901 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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