1992788533 NPI number — PERRYSBURG CITY OFFICE OF CORPORATION CLERK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992788533 NPI number — PERRYSBURG CITY OFFICE OF CORPORATION CLERK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRYSBURG CITY OFFICE OF CORPORATION CLERK
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:
1992788533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 W INDIANA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRYSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43551-1525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-872-8025
Provider Business Mailing Address Fax Number:
419-872-8079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 W INDIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRYSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43551-1577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-872-8025
Provider Business Practice Location Address Fax Number:
419-872-8079
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRANANTA
Authorized Official First Name:
TOM
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT CHIEF
Authorized Official Telephone Number:
419-872-8026

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10041 . This is a "PARAMOUNT HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 356089400 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 590175518 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0307966 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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