1720378128 NPI number — GALAHADD'S QUEST LLC

Table of content: (NPI 1720378128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720378128 NPI number — GALAHADD'S QUEST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GALAHADD'S QUEST 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:
REICHARDT FAMILY PRACTICE
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:
1720378128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 BATON ROUGE
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45805-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-331-2273
Provider Business Mailing Address Fax Number:
419-331-4274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 BATON ROUGE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45805-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-331-2273
Provider Business Practice Location Address Fax Number:
419-331-4274
Provider Enumeration Date:
04/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REICHARDT
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
419-331-2273

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  COA10079-NP , 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: 0B51149 . This is a "BCBS-OH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: A503JREICHART:80561 . This is a "PERSE ESN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6268010001 . This is a "MEDICARE DME" identifier . This identifiers is of the category "OTHER".
  • Identifier: H006310 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0B51149 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com