1720045636 NPI number — LARRY M TINCHER MD

Table of content: LARRY M TINCHER MD (NPI 1720045636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720045636 NPI number — LARRY M TINCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TINCHER
Provider First Name:
LARRY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1720045636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:
937-619-4231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
629 SANDUSKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCYRUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44820-1821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-562-4677
Provider Business Practice Location Address Fax Number:
419-562-0987
Provider Enumeration Date:
04/26/2006

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: 207P00000X , with the licence number:  35069322 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 35069322 , 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: 000000384730 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2054913 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000316698 . This is a "BCBS FOR BUCYRUS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00097358 . This is a "RR MEDICARE FOR BUCYRUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0188658 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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