1225007016 NPI number — DR. CHARLES P HOUSE SR. DO

Table of content: DR. CHARLES P HOUSE SR. DO (NPI 1225007016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225007016 NPI number — DR. CHARLES P HOUSE SR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSE
Provider First Name:
CHARLES
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1225007016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 179
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44811-0179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-274-5000
Provider Business Mailing Address Fax Number:
440-716-8608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 W MCPHERSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLYDE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43410-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-547-0584
Provider Business Practice Location Address Fax Number:
419-547-8918
Provider Enumeration Date:
03/15/2006

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: 207Q00000X , with the licence number:  34-007179 , 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: 000000351615 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 20711612 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 58182 . This is a "NATIONWIDE HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00180079 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04663 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2158472 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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