1285820977 NPI number — POWELL FAMILY MEDICINE, INC

Table of content: (NPI 1285820977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285820977 NPI number — POWELL FAMILY MEDICINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POWELL 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:
1285820977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10330 SAWMILL PKWY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43065-7790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-766-4900
Provider Business Mailing Address Fax Number:
614-766-4984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10330 SAWMILL PKWY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43065-7790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-766-4900
Provider Business Practice Location Address Fax Number:
614-766-4984
Provider Enumeration Date:
09/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BREZNY
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-766-4900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35081093 , 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: 2351940 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: PO9327821 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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