1487200838 NPI number — MR. JOSEPH WILLARD HERSHEY A.T.,C./L

Table of content: MR. JOSEPH WILLARD HERSHEY A.T.,C./L (NPI 1487200838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487200838 NPI number — MR. JOSEPH WILLARD HERSHEY A.T.,C./L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERSHEY
Provider First Name:
JOSEPH
Provider Middle Name:
WILLARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
A.T.,C./L
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:
1487200838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1041 MILLER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43420-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-332-7469
Provider Business Mailing Address Fax Number:
419-334-5450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43420-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-680-5827
Provider Business Practice Location Address Fax Number:
419-334-5450
Provider Enumeration Date:
08/12/2019

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: 2081S0010X , with the licence number:  AT-61 , 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)





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