1881627990 NPI number — JANICE LEDREW OD

Table of content: JANICE LEDREW OD (NPI 1881627990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881627990 NPI number — JANICE LEDREW OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEDREW
Provider First Name:
JANICE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1881627990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 SYLVANIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45440-3281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-320-2020
Provider Business Mailing Address Fax Number:
937-320-0504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 SYLVANIA DR
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:
45440-3281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-320-2020
Provider Business Practice Location Address Fax Number:
937-320-0504
Provider Enumeration Date:
07/09/2006

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: 152W00000X , with the licence number:  3209T536 , 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: 0469925 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881627990 . This is a "NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000005917 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2220162 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 410035812 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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