1952394348 NPI number — JED E KOHNE PA C

Table of content: JED E KOHNE PA C (NPI 1952394348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952394348 NPI number — JED E KOHNE PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHNE
Provider First Name:
JED
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA C
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:
1952394348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 S KNOXVILLE AVE STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT MARYS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45885-2609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-300-1129
Provider Business Mailing Address Fax Number:
419-586-1257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 HAMILTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45822-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-586-5760
Provider Business Practice Location Address Fax Number:
419-586-1257
Provider Enumeration Date:
08/31/2005

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:  50002151 , 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: 1184652539 . This is a "GROUP NPI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0105065 . This is a "GROUP MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0216503 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34-1689161 . This is a "TAX ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9934723 . This is a "GROUP MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H546170 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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