1528285103 NPI number — DARKE COUNTY INTERNAL MEDICINE-PEDIATRICS, INC.

Table of content: (NPI 1528285103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528285103 NPI number — DARKE COUNTY INTERNAL MEDICINE-PEDIATRICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARKE COUNTY INTERNAL MEDICINE-PEDIATRICS, INC.
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:
1528285103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 WEST MARTZ STREET
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-548-3868
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 WEST MARTZ STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-548-3868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAWLEY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-548-3868

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35069759 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 35069759 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2012253 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com