1952583627 NPI number — OUTREACH PROFESSIONAL SERVICES INC

Table of content: GUNNAR JAMES NEMITZ MD (NPI 1811635394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952583627 NPI number — OUTREACH PROFESSIONAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTREACH PROFESSIONAL SERVICES INC
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:
6
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:
1952583627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7580 NORTHCLIFF AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44144-3270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-472-2730
Provider Business Mailing Address Fax Number:
216-472-2740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6701 ROCKSIDE RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-2358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-369-2800
Provider Business Practice Location Address Fax Number:
216-369-0456
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOWRER
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
216-472-2741

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0251856 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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