1811944531 NPI number — PREMIER CARDIOTHORACIC AND VASCULAR SURGEONS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811944531 NPI number — PREMIER CARDIOTHORACIC AND VASCULAR SURGEONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER CARDIOTHORACIC AND VASCULAR SURGEONS INC
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:
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:
1811944531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 73392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44193-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-293-0247
Provider Business Mailing Address Fax Number:
937-293-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E APPLE ST STE 6200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-275-5100
Provider Business Practice Location Address Fax Number:
937-275-4587
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
KOK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-275-5100

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000039029 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DB6525 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2149946 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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