1043300031 NPI number — INTERNAL MEDICINE PHYSICIANS OF CENTRAL OHIO LLC

Table of content: (NPI 1043300031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043300031 NPI number — INTERNAL MEDICINE PHYSICIANS OF CENTRAL OHIO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE PHYSICIANS OF CENTRAL OHIO 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:
1043300031
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:
660 LONDON AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43040-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-642-1550
Provider Business Mailing Address Fax Number:
937-578-2717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 LONDON AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43040-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-642-1550
Provider Business Practice Location Address Fax Number:
937-578-2717
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUNIYAPPA
Authorized Official First Name:
PRASANNA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PHYSICIAN MEMBER
Authorized Official Telephone Number:
937-642-1550

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2565282 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com