1134184559 NPI number — ALPHA WOUND CARE,LLC

Table of content: (NPI 1134184559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134184559 NPI number — ALPHA WOUND CARE,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA WOUND CARE,LLC
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:
1134184559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 485
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45061-0485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-623-0305
Provider Business Mailing Address Fax Number:
513-738-3038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3363 SPYGLASS RDG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45013-8404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-623-0305
Provider Business Practice Location Address Fax Number:
513-738-3038
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KENNERLY
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
513-623-0305

Provider Taxonomy Codes

  • Taxonomy code: 163WW0000X , 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: 2244226 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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