1427085273 NPI number — V CLEW, LLC

Table of content: (NPI 1427085273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427085273 NPI number — V CLEW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
V CLEW, 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:
1427085273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 RIVER VALLEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43130-1659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-687-2273
Provider Business Mailing Address Fax Number:
740-687-9059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 RIVER VALLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-1659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-687-2273
Provider Business Practice Location Address Fax Number:
740-687-9059
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
TINA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
740-687-2273

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1472340 , 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: VC9346191 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 02-1472800 . This is a "OHIO FACILITY PHARMACY LI" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 36D03280453 . This is a "CLIA ID NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 980524 . This is a "OBWC NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 10E0884201 . This is a "ODH RADIATION LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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