1114926987 NPI number — SANTOSH KHURMA MD

Table of content: SANTOSH KHURMA MD (NPI 1114926987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114926987 NPI number — SANTOSH KHURMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHURMA
Provider First Name:
SANTOSH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1114926987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 N PROGRESS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
XENIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45385-2666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-562-2280
Provider Business Mailing Address Fax Number:
937-562-2282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 N. PROGRESS DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
XENIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-374-4041
Provider Business Practice Location Address Fax Number:
937-374-4020
Provider Enumeration Date:
07/14/2005

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: 207RG0300X , with the licence number:  35046068 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35046068 , 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: P00432943 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0687109 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000012488 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 110089376 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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