1396735502 NPI number — K L DABE AND ASSOCIATES INC

Table of content: (NPI 1396735502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396735502 NPI number — K L DABE AND ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K L DABE AND ASSOCIATES INC
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:
1396735502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7537 EASY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-9421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-573-9625
Provider Business Mailing Address Fax Number:
513-573-9628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7537 EASY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040-9421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-573-9625
Provider Business Practice Location Address Fax Number:
513-573-9628
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DABE
Authorized Official First Name:
KIMBALL
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-573-9625

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  HMER22180 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: HMER22180 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: HMER22180 , 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: 200169410A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2196645 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 69000563A . This is a "INDIANA DME LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 90002122 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: HMER 22180 . This is a "OHIO DME LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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