1356463103 NPI number — MR. JEFFREY TODD BISHOP LSW

Table of content: FARSHAD NAYSAN (NPI 1700503521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356463103 NPI number — MR. JEFFREY TODD BISHOP LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISHOP
Provider First Name:
JEFFREY
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
M

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:
1356463103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10100 ELIDA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELPHOS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45833-9056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-685-8010
Provider Business Mailing Address Fax Number:
419-932-6232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1624 TIFFIN AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FINDLAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45840-6852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-427-3320
Provider Business Practice Location Address Fax Number:
419-427-1697
Provider Enumeration Date:
04/04/2007

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: 104100000X , with the licence number:  S 0020397 , 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)