1285605329 NPI number — PETER EUGENE PERZANOWSKI DC

Table of content: PETER EUGENE PERZANOWSKI DC (NPI 1285605329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285605329 NPI number — PETER EUGENE PERZANOWSKI DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERZANOWSKI
Provider First Name:
PETER
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1285605329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
300 HOWARD ST STE 2
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-633-3161
Provider Business Mailing Address Fax Number:
740-633-3161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HOWARD ST
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-633-3161
Provider Business Practice Location Address Fax Number:
740-633-3161
Provider Enumeration Date:
01/27/2006

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: 111N00000X , with the licence number:  1287 , 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: 0132022000 . This is a "WV MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0661172 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1287A . This is a "THE HEALTH PLAN PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34177511100 . This is a "OHIO WORK COMP BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 001716296 . This is a "SERVICE ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1484138 . This is a "HEATTHI RETIREAT FUNDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001708126 . This is a "PAY TO ID #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341775111 . This is a "WV WORK COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1287 . This is a "THE HEALTH PLAN PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4484446 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000138352 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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