1295111318 NPI number — IMPERIAL ENTERPRISE OF OHIO LLC

Table of content: GABRIELLE ICELE FLYNT DNP (NPI 1467249011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295111318 NPI number — IMPERIAL ENTERPRISE OF OHIO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMPERIAL ENTERPRISE OF OHIO LLC
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:
6
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:
1295111318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 340765
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45434-0765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-554-3683
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 W ELMWOOD DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459-4259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-554-3683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/31/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHAHID
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-554-3683

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com