1336166289 NPI number — CARNES, MONTGOMERY, COOK & HENRY, ORAL & MAX SURG, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336166289 NPI number — CARNES, MONTGOMERY, COOK & HENRY, ORAL & MAX SURG, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARNES, MONTGOMERY, COOK & HENRY, ORAL & MAX SURG, 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:
1336166289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6641 N HIGH ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
WORTHINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43085-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-885-3339
Provider Business Mailing Address Fax Number:
614-885-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6641 N HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WORTHINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43085-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-885-3339
Provider Business Practice Location Address Fax Number:
614-885-1011
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRASSETTE
Authorized Official First Name:
MEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
INSURANCE COORDINATOR
Authorized Official Telephone Number:
614-885-3339

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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