1952399545 NPI number — DARRELL LEROY WOLFE JR. CRNA

Table of content: STEVEN W CIMERBERG D.O (NPI 1760667968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952399545 NPI number — DARRELL LEROY WOLFE JR. CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
DARRELL
Provider Middle Name:
LEROY
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
CRNA
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:
1952399545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 711841
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43271-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-346-9400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25526-9202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-346-9400
Provider Business Practice Location Address Fax Number:
304-345-7320
Provider Enumeration Date:
10/09/2005

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: 163W00000X , with the licence number:  1103273 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: APN0000010406 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 07240 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 054720 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 006930 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200253980 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073324 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 7400958000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000540386 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2376263 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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