1114920329 NPI number — WRIGHT STATE PHYSICIANS INC

Table of content: (NPI 1114920329)

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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