1033409222 NPI number — KSK HEALTH SERVICES LLC

Table of content: (NPI 1033409222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033409222 NPI number — KSK HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KSK HEALTH SERVICES 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:
1033409222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6929 W 130TH ST
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
PARMA HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-7895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-481-3055
Provider Business Mailing Address Fax Number:
440-481-3222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6929 W 130TH ST
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
PARMA HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-7895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-481-3055
Provider Business Practice Location Address Fax Number:
440-481-3222
Provider Enumeration Date:
04/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KIDD
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGER/CEO
Authorized Official Telephone Number:
440-481-3055

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35099315 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E0004052 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E0900389 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 35060650 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: E0007819 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: I0007634 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6890 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 35060650 , 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: 12634224 . This is a "PROVIDER CAQH #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3349058 . This is a "UHC/UBH PROVIDER ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 393335 . This is a "PROVIDER MHN (HEALTHNET) ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 687211 . This is a "VO GROUP PROVIDER ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 11744590 . This is a "PROVIDER CAQH #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 12638930 . This is a "PROVIDER CAQH #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0051324 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 587502 . This is a "PROVIDER VO ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0084596 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11753827 . This is a "PROVIDER CAQH #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2967384 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 687211 . This is a "VO MILITARY ONE GROUP PROVIDER ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2908413 . This is a "PROVIDER UHC/UBH ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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