1477689420 NPI number — SUSAN ELAINE BURNHEIMER

Table of content: SUSAN ELAINE BURNHEIMER (NPI 1477689420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477689420 NPI number — SUSAN ELAINE BURNHEIMER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNHEIMER
Provider First Name:
SUSAN
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1477689420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13450 HARMON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICKERINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43147-8429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-861-6592
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIRCLEVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43113-1916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-474-8577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2007

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: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2300549 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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