1528062171 NPI number — DAVID E CHILDS JR

Table of content: DR. APRIL DIONE ADAMS MD (NPI 1497054993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528062171 NPI number — DAVID E CHILDS JR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID E CHILDS JR
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:
1528062171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 WABASH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44613-1042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-767-3451
Provider Business Mailing Address Fax Number:
330-767-3452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 CHERRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44601-5022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-821-3939
Provider Business Practice Location Address Fax Number:
330-829-9734
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHILDS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
330-821-3939

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  3494 , 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: 0574196 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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