1093932691 NPI number — RIVERVIEW ENT CENTER OF CENTRAL OHIO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093932691 NPI number — RIVERVIEW ENT CENTER OF CENTRAL OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW ENT CENTER OF CENTRAL OHIO
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:
1093932691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2405 N COLUMBUS ST STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-8186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-681-8300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2405 N COLUMBUS ST STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-8186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-681-8300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASTELLON
Authorized Official First Name:
ROBERTO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
740-681-8300

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  PR9214 , 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)





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