1003809088 NPI number — ANDREW CARRINGTON GOMBASH D.O.

Table of content: ANDREW CARRINGTON GOMBASH D.O. (NPI 1003809088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003809088 NPI number — ANDREW CARRINGTON GOMBASH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOMBASH
Provider First Name:
ANDREW
Provider Middle Name:
CARRINGTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOMBASH
Provider Other First Name:
ANDREW
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003809088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 E RIVERVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPOLEON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43545-9805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-592-1071
Provider Business Mailing Address Fax Number:
419-592-1076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 E RIVERVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPOLEON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43545-9805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
194-592-1071
Provider Business Practice Location Address Fax Number:
194-592-1076
Provider Enumeration Date:
08/25/2005

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: 207Q00000X , with the licence number:  34004365G , 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: 311155352 . This is a "EMERALD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "EV BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "CENTRAL BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "PPO NEXT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "OHIO HEALTH CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000260293 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "MEDIGOLD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0146765 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311155352 . This is a "NATIONWIDE INS." identifier . This identifiers is of the category "OTHER".
  • Identifier: 0109967 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311155352001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311155352 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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