1194805150 NPI number — JAMES K HORLACHER MD INC

Table of content: MRS. SAMANTHA JEAN MULKITEN NP (NPI 1801407119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194805150 NPI number — JAMES K HORLACHER MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES K HORLACHER MD 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:
1194805150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WYOMING ST
Provider Second Line Business Mailing Address:
SUITE 4140
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45409-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-208-4110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WYOMING ST
Provider Second Line Business Practice Location Address:
SUITE 4140
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45409-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-208-4110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORLACHER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
KYLE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
937-208-4110

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  35033673 , 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: 0169339 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4013797 . This is a "AETNA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000012161 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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