1841569902 NPI number — DR GINA REGHETTI DO PC INC

Table of content: (NPI 1841569902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841569902 NPI number — DR GINA REGHETTI DO PC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR GINA REGHETTI DO PC 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:
1841569902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE 110 BUILDING
Provider Second Line Business Mailing Address:
110 EDWARD STREET, NW
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44483-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-847-3334
Provider Business Mailing Address Fax Number:
330-847-9301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE 110 BUILDING
Provider Second Line Business Practice Location Address:
110 EDWARD STREET, NW
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44483-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-847-3334
Provider Business Practice Location Address Fax Number:
330-847-9301
Provider Enumeration Date:
12/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REGHETTI
Authorized Official First Name:
DR. GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/SURGEON
Authorized Official Telephone Number:
330-847-3334

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 34-006816-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000012833-00 . This is a "OHIO BUREAU OF WORKERS' COMPENSATION CERTIFIED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 34-006816-R . This is a "STATE OF OHIO MEDICAL LICENSE # 34-006816-R" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2174418 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36D2026176 . This is a "CLIA WAIVER CERTIFICATE # 36D2026176 ACUTE OPIOID DETOX CLINIC, U.S.A." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 8873 . This is a "AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS BOARD CERTIFICATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: RE 4018311 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 064509 . This is a "AOA # AMERICAN OSTEOPATHIC ASSOCIATION ID# 064509" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H051310 . This is a "MEDICARE ID AS OF 7-17-2013" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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