1457530487 NPI number — ROBERT G. SPRATT, M.D. INC.

Table of content: (NPI 1457530487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457530487 NPI number — ROBERT G. SPRATT, M.D. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT G. SPRATT, M.D. 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:
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:
1457530487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231 E MIDLOTHIAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44507-1947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
300-788-4097
Provider Business Mailing Address Fax Number:
330-788-4061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 E MIDLOTHIAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YOUNGSTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44507-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
300-788-4097
Provider Business Practice Location Address Fax Number:
330-788-4061
Provider Enumeration Date:
10/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPRATT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-788-4097

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35-04-9573S , 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: 9200101 . This is a "PTAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2342996 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000126547 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DN5046 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 080004716 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9200101 . This is a "MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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