1750383568 NPI number — KRISTEL L WARD DO

Table of content: (NPI 1447656442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750383568 NPI number — KRISTEL L WARD DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
KRISTEL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1750383568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 BEAVER CREEK CIR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MAUMEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43537-1745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-891-6201
Provider Business Mailing Address Fax Number:
419-893-1227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 BEAVER CREEK CIR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MAUMEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43537-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-891-6201
Provider Business Practice Location Address Fax Number:
419-893-1227
Provider Enumeration Date:
08/11/2005

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: 207V00000X , with the licence number:  34004638 , 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: 2088457 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000141230 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 01510 . This is a "PHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0933566 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160041502 . This is a "RRMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07-01419 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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