1720018971 NPI number — PIKE HEALTH SERVICES, INC

Table of content: (NPI 1720018971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720018971 NPI number — PIKE HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIKE HEALTH SERVICES, INC
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:
PIKE COMMUNITY HOSPITAL; PIKE MEDICAL & SURGICAL ASSOCIATES
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:
1720018971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
272 HOSPITAL RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601-9031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-779-4460
Provider Business Mailing Address Fax Number:
740-779-4257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 DAWN LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAVERLY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45690-9138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-947-2186
Provider Business Practice Location Address Fax Number:
740-947-6538
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARLSON
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
740-779-7582

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  1299 , 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: 1299 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 1299 , 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: 037358600 . This is a "HOSPITAL - DOL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000156779 . This is a "HOSPITAL - ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6942509 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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