1912959883 NPI number — JAMES PATRICK STITH II PAC

Table of content: JAMES PATRICK STITH II PAC (NPI 1912959883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912959883 NPI number — JAMES PATRICK STITH II PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STITH
Provider First Name:
JAMES
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
PAC
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:
1912959883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4750 HEMPSTEAD STATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KETTERING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45429-5164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-875-0136
Provider Business Mailing Address Fax Number:
937-619-4231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 MACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-5335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-870-7001
Provider Business Practice Location Address Fax Number:
513-603-8174
Provider Enumeration Date:
05/17/2006

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: 363A00000X , with the licence number:  50000996 , 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: P00145490 . This is a "RR MEDICARE FAIRFIELD" identifier . This identifiers is of the category "OTHER".




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