1033166913 NPI number — NEIL F. GRABENSTETTER MD

Table of content: (NPI 1033166913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033166913 NPI number — NEIL F. GRABENSTETTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIL F. GRABENSTETTER MD
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:
1033166913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6605 CENTER RD
Provider Second Line Business Mailing Address:
PO BOX 463
Provider Business Mailing Address City Name:
VALLEY CITY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44280-9748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-483-3135
Provider Business Mailing Address Fax Number:
330-483-3878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6605 CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44280-9748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-483-3135
Provider Business Practice Location Address Fax Number:
330-483-3878
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRABENSTETTER
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-483-3135

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35045377G , 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: 1689674277 . This is a "INDIV. NPI NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0464297 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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