1972118495 NPI number — THOMAS EDISON CENTER, INC.

Table of content: ANGELA TRUC DAN CAO MD (NPI 1689107369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972118495 NPI number — THOMAS EDISON CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS EDISON CENTER, 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:
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:
1972118495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 604
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN WERT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45891-0604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-771-1313
Provider Business Mailing Address Fax Number:
419-771-1315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 AUGUSTINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN WERT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45891-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-605-2853
Provider Business Practice Location Address Fax Number:
419-771-1315
Provider Enumeration Date:
09/11/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ETTER
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
419-771-1313

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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