1316907827 NPI number — DR. TINA MARIE TRZASKA JOYCE DO

Table of content: DR. TINA MARIE TRZASKA JOYCE DO (NPI 1316907827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316907827 NPI number — DR. TINA MARIE TRZASKA JOYCE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOYCE
Provider First Name:
TINA MARIE
Provider Middle Name:
TRZASKA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRZASKA
Provider Other First Name:
TINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316907827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8007 AUBURN RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
CONCORD TWP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-375-5520
Provider Business Mailing Address Fax Number:
440-350-0955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8007 AUBURN RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CONCORD TWP
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44077-9610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-375-5502
Provider Business Practice Location Address Fax Number:
440-350-0955
Provider Enumeration Date:
03/27/2006

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: 207Q00000X , with the licence number:  34-008375 , 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: 264200000 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2631567 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6600162 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 264200000 . This is a "DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 80507 . This is a "QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341425870042 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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