1275718645 NPI number — SUSAN MARIE ARCENEAUX MD INC

Table of content: DR. JOSEPH ARLO BENSON D.O. (NPI 1831350123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275718645 NPI number — SUSAN MARIE ARCENEAUX MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN MARIE ARCENEAUX 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:
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:
1275718645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 E WASHINGTON ST
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-721-4776
Provider Business Mailing Address Fax Number:
330-725-0054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44256-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-721-4776
Provider Business Practice Location Address Fax Number:
330-725-0054
Provider Enumeration Date:
01/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARCENEAUX
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-721-4776

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35063143 , 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: 0903080 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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