1003022260 NPI number — MRS. MICHELE CELESTE EDGINGTON C.C.P.

Table of content: MRS. MICHELE CELESTE EDGINGTON C.C.P. (NPI 1003022260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003022260 NPI number — MRS. MICHELE CELESTE EDGINGTON C.C.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EDGINGTON
Provider First Name:
MICHELE
Provider Middle Name:
CELESTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.C.P.
Provider Gender Code:
F

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:
1003022260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10172 JENWOOD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STREETSBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44241-4312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-653-8268
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6780 MAYFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-312-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007

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: 242T00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 970063 . This is a "ABCP I.D." identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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