1225258114 NPI number — FAR OAKS ORTHOPEDISTS, INC

Table of content: DR. GABRIELLA LAFERRIERE DNP, FNP (NPI 1861266298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225258114 NPI number — FAR OAKS ORTHOPEDISTS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAR OAKS ORTHOPEDISTS, 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:
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:
1225258114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6490 CENTERVILLE BUSINESS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45459-2633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-433-5309
Provider Business Mailing Address Fax Number:
937-433-1340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3737 SOUTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-433-5309
Provider Business Practice Location Address Fax Number:
937-433-1340
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLEINHENZ
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
937-433-5309

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DC5010 . This is a "REDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0379399 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2758494 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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