1750384632 NPI number — PETER J MUIR M.D.

Table of content: PETER J MUIR M.D. (NPI 1750384632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750384632 NPI number — PETER J MUIR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUIR
Provider First Name:
PETER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1750384632
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/31/2019
NPI Reactivation Date:
09/26/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3250 MIDDLE URBANA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45502-9285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-399-7777
Provider Business Mailing Address Fax Number:
937-399-6794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3250 MIDDLE URBANA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45502-9285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-399-7777
Provider Business Practice Location Address Fax Number:
937-399-6794
Provider Enumeration Date:
05/24/2005

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: 207Q00000X , with the licence number:  35-06-2843-M , 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: 080068219 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311202780006 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4293529 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: OH0031308 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0101872 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0915139 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000013715 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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