1902089113 NPI number — JILL B VOSLER

Table of content: (NPI 1902089113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902089113 NPI number — JILL B VOSLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JILL B VOSLER
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:
1902089113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450B WASHINGTON JACKSON RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
EATON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45320-7600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-456-8350
Provider Business Mailing Address Fax Number:
937-456-8351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450B WASHINGTON JACKSON RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
EATON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45320-7600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-456-8350
Provider Business Practice Location Address Fax Number:
937-456-8351
Provider Enumeration Date:
12/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TYLER
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
937-456-8350

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34004807 , 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: 000000177350 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0748472 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 289663054004 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3043398 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2220960 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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