1730329020 NPI number — MS. ANDREA ERIN YOUNG H.I.S., A.B.O.C.

Table of content: MS. ANDREA ERIN YOUNG H.I.S., A.B.O.C. (NPI 1730329020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730329020 NPI number — MS. ANDREA ERIN YOUNG H.I.S., A.B.O.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
ANDREA
Provider Middle Name:
ERIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
H.I.S., A.B.O.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAHL
Provider Other First Name:
ANDREA
Provider Other Middle Name:
ERIN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
H.I.S., A.B.O.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730329020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 W STATE ROUTE 18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIFFIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44883-8950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-443-0710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 S COUNTY ROAD 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIFFIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44883-9746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-443-0710
Provider Business Practice Location Address Fax Number:
419-443-0576
Provider Enumeration Date:
02/25/2009

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: 156FX1800X , with the licence number:  7183 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 2823 , 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)





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