1386601169 NPI number — MR. KEITH E HEDGES DC

Table of content: MR. KEITH E HEDGES DC (NPI 1386601169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386601169 NPI number — MR. KEITH E HEDGES DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEDGES
Provider First Name:
KEITH
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1386601169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 HARROUN ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVANIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-882-6455
Provider Business Mailing Address Fax Number:
419-882-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5525 HARROUN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-882-6455
Provider Business Practice Location Address Fax Number:
419-932-6230
Provider Enumeration Date:
04/27/2006

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: 111N00000X , with the licence number:  2301005948 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 672 , 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: 0333731 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31091906700 . This is a "BUREAU OF WORKERS COMPENS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 350001993 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117520 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 955066 . This is a "AETNA HEALTH INC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0004279160 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 310919067005 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 901 . This is a "PARAMOUNT HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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