1104090422 NPI number — MR. SPENCER STEVEN SEEFELDT

Table of content: MR. SPENCER STEVEN SEEFELDT (NPI 1104090422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104090422 NPI number — MR. SPENCER STEVEN SEEFELDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEEFELDT
Provider First Name:
SPENCER
Provider Middle Name:
STEVEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1104090422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3819 STIMSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44203-6445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-687-1230
Provider Business Mailing Address Fax Number:
330-668-2158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3819 STIMSON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44203-6445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-687-1230
Provider Business Practice Location Address Fax Number:
330-668-2158
Provider Enumeration Date:
04/17/2008

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: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2334727 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com