1922111251 NPI number — DALLAS G AUVIL MD

Table of content: DALLAS G AUVIL MD (NPI 1922111251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922111251 NPI number — DALLAS G AUVIL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUVIL
Provider First Name:
DALLAS
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1922111251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4685 FOREST AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-3359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-862-2692
Provider Business Mailing Address Fax Number:
513-862-1584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 DIXMYTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINTI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45220-2475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-862-2692
Provider Business Practice Location Address Fax Number:
513-862-1584
Provider Enumeration Date:
08/17/2006

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: 2084P0800X , with the licence number:  35054142 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: 35054142 , 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: 000000020581 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195110000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6409372700 . This is a "KENTUCKY MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200290120A . This is a "INDIANA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260043102 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31153618600 . This is a "BWC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0158645 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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