1063539062 NPI number — NEUMED

Table of content: DR. CONRAD B. BLUM M.D. (NPI 1578507018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063539062 NPI number — NEUMED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUMED
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:
1063539062
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:
9906 NORWALK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITCHFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44253-9502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-721-4747
Provider Business Mailing Address Fax Number:
330-721-0726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9906 NORWALK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITCHFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44253-9502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-721-4747
Provider Business Practice Location Address Fax Number:
330-721-0726
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEUENDORFF
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-721-4747

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X , with the licence number:  RCP 1458 , 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: NEID00891 . This is a "INDEPENDENT LABORATORY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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