1821091331 NPI number — DR. EDWARD A HUBACH D.O.

Table of content: DR. EDWARD A HUBACH D.O. (NPI 1821091331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821091331 NPI number — DR. EDWARD A HUBACH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUBACH
Provider First Name:
EDWARD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1821091331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2912 SPRINGBORO W
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-297-8999
Provider Business Mailing Address Fax Number:
937-297-4852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6255 CHAMBERSBURG ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUBER HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-233-7141
Provider Business Practice Location Address Fax Number:
937-233-1956
Provider Enumeration Date:
05/30/2005

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:  34002371H , 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: 220226705 . This is a "DEPT. OF LABOR WC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0279087 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080191719 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: D0237103 . This is a "HUMANA/CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 635756 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0120089 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34002371 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 421534506094 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000227899 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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