1467583203 NPI number — ATHENS MEDICAL ASSOCIATES, LLC

Table of content: (NPI 1467583203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467583203 NPI number — ATHENS MEDICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHENS MEDICAL ASSOCIATES, 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:
1467583203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 W UNION ST
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45701-2331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-594-7979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 HOSPITAL DR
Provider Second Line Business Practice Location Address:
STE 260
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-594-8819
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAER
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
740-594-7979

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  NP09347 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 367A00000X , with the licence number: NM09326 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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