1285765008 NPI number — ARBOR VIEW FAMILY MEDICINE, INC.

Table of content: (NPI 1285765008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285765008 NPI number — ARBOR VIEW FAMILY MEDICINE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARBOR VIEW FAMILY MEDICINE, 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:
1285765008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1941 W FAIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-9671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-689-3627
Provider Business Mailing Address Fax Number:
740-687-5898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1941 W FAIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-9671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-689-3627
Provider Business Practice Location Address Fax Number:
740-687-5898
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WESTFALL
Authorized Official First Name:
TOSHA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
740-687-2150

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  207Q00000X , 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: 389477 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 699696 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35041207 . This is a "DR LLOYD MED LIC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 35055843 . This is a "DR SCOGGIN MED LIC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 744654 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35053851 . This is a "DR SIELSKI MED LIC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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