1154427854 NPI number — BLANCHARD VALLEY VASCULAR SURGERY ASSOCIATES LLC

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 1154427854 NPI number — BLANCHARD VALLEY VASCULAR SURGERY ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLANCHARD VALLEY VASCULAR SURGERY ASSOCIATES 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:
1154427854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 450637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAKE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44145-0611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-514-4390
Provider Business Mailing Address Fax Number:
440-808-3675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 S MAIN ST
Provider Second Line Business Practice Location Address:
CDS SUITE 349
Provider Business Practice Location Address City Name:
FINDLAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45840-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-420-9175
Provider Business Practice Location Address Fax Number:
419-420-3674
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALONE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
419-420-9175

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD4087 . This is a "RAILROAD CARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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