1003917154 NPI number — MOORTHY MEDICAL ASSOCIATES, LLC

Table of content: (NPI 1003917154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003917154 NPI number — MOORTHY MEDICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOORTHY MEDICAL ASSOCIATES, LLC
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:
1003917154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 643273
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:
45264-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-891-2813
Provider Business Mailing Address Fax Number:
513-793-1032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 NILLES RD
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45014-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-858-6555
Provider Business Practice Location Address Fax Number:
513-858-6222
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORTHY
Authorized Official First Name:
PALANIVEL
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
513-858-6555

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA5393 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com