1477850451 NPI number — DR. JAMES GREGORY WASHAM JR. D.C.

Table of content: DR. JAMES GREGORY WASHAM JR. D.C. (NPI 1477850451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477850451 NPI number — DR. JAMES GREGORY WASHAM JR. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHAM
Provider First Name:
JAMES
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1477850451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 WALL ST
Provider Second Line Business Mailing Address:
STE Q
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-2789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-531-2277
Provider Business Mailing Address Fax Number:
513-531-2278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 BEECHMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45255-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-231-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2011

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: 111N00000X , with the licence number:  4189 , 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: 0052777 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".