1053557553 NPI number — .GREGORY W. PASTRICK, D.C. LLC

Table of content: (NPI 1053557553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053557553 NPI number — .GREGORY W. PASTRICK, D.C. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
.GREGORY W. PASTRICK, D.C. 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:
1053557553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
184 OVERLOOK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRUTHERS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44471-1615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-518-7795
Provider Business Mailing Address Fax Number:
330-729-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 E WESTERN RESERVE RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
POLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44514-4359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-519-7795
Provider Business Practice Location Address Fax Number:
330-729-1101
Provider Enumeration Date:
01/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PASTRICK
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
330-518-7795

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1371 , 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: 0182065 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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