1962045039 NPI number — SAMUEL ROHAN ESHLEMAN LATIMER M.A.

Table of content: STEPHANIE LYNN TACKETT (NPI 1962927301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962045039 NPI number — SAMUEL ROHAN ESHLEMAN LATIMER M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESHLEMAN LATIMER
Provider First Name:
SAMUEL
Provider Middle Name:
ROHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER-ESHLEMAN
Provider Other First Name:
SAMUEL
Provider Other Middle Name:
ROHAN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962045039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
994 DANA AVE APT 1
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:
45229-1488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-498-1778
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2621 VICTORY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45206-1754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-221-4673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2019

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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