1477877298 NPI number — ESSENT HEALTHCARE - GEORGETOWN LLC

Table of content: (NPI 1477877298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477877298 NPI number — ESSENT HEALTHCARE - GEORGETOWN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESSENT HEALTHCARE - GEORGETOWN 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:
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:
1477877298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
474 HOME ST
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45121-1459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-378-7150
Provider Business Mailing Address Fax Number:
937-378-7151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
474 HOME ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45121-1459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-378-7150
Provider Business Practice Location Address Fax Number:
937-378-7151
Provider Enumeration Date:
03/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FICK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SECRETARY TREASURER
Authorized Official Telephone Number:
615-312-5108

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com