1235280355 NPI number — MR. GUY MICHAEL NAPLES MA CCC SP A

Table of content: MR. GUY MICHAEL NAPLES MA CCC SP A (NPI 1235280355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235280355 NPI number — MR. GUY MICHAEL NAPLES MA CCC SP A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAPLES
Provider First Name:
GUY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA CCC SP A
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:
1235280355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
494 W CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELAWARE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43015-1470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-369-3650
Provider Business Mailing Address Fax Number:
740-369-0812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3940 NORTHHAMPTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43065-8442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-369-3650
Provider Business Practice Location Address Fax Number:
740-369-0812
Provider Enumeration Date:
01/15/2007

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: 231H00000X , with the licence number:  A00163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X , with the licence number: SP1830 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2095254 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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