1073777066 NPI number — MR. AARON MICHAEL COOTS MSW, LSW

Table of content: (NPI 1326557075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073777066 NPI number — MR. AARON MICHAEL COOTS MSW, LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOTS
Provider First Name:
AARON
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LSW
Provider Gender Code:
M

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:
1073777066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4317 WEBSTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45236-3639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-385-9600
Provider Business Mailing Address Fax Number:
513-385-3771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10700 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-3255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-385-9600
Provider Business Practice Location Address Fax Number:
513-385-3771
Provider Enumeration Date:
07/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  S0800233 , 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: 01274 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31-0536968 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".