1114920329 NPI number — WRIGHT STATE PHYSICIANS INC

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 1114920329 NPI number — WRIGHT STATE PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRIGHT STATE PHYSICIANS INC
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:
6
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:
1114920329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBORN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45324-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-245-7100
Provider Business Mailing Address Fax Number:
937-245-7999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45435-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-245-7100
Provider Business Practice Location Address Fax Number:
937-245-7999
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PAUL
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
937-245-7125

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 821388 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1205197985 . This is a "SUBPART NPI DME MOB" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0914443 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1427299841 . This is a "NCS SUBPARTSURG ONC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3610562 . This is a "MEDICARE PTAN ASC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1306087515 . This is a "NCS SUBPART PLSTC SURG 6257" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417133380 . This is a "ORTHO DME SUBGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1649447582 . This is a "ASC SUBGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0654700009 . This is a "NSC SUITE 5253" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1215178421 . This is a "NSC SUBPART VASC SURG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1295977254 . This is a "ASC DME NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10654700002 . This is a "MEDICARE DME PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1316188147 . This is a "SURGERY DME SUBGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 821388 . This is a "BUSINESS LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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