1578545752 NPI number — DR. ALFRED M SASSLER DO

Table of content: DR. ALFRED M SASSLER DO (NPI 1578545752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578545752 NPI number — DR. ALFRED M SASSLER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SASSLER
Provider First Name:
ALFRED
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1578545752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7690 DISCOVERY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45069-6542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-475-8400
Provider Business Mailing Address Fax Number:
513-475-8228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7690 DISCOVERY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45069-6542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-475-8400
Provider Business Practice Location Address Fax Number:
513-475-8228
Provider Enumeration Date:
11/15/2005

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: 207Y00000X , with the licence number:  02420 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 34006187 , 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: 02420 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64024201 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000050862 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0986107 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810011191 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6112740750000 . This is a "BLUEGRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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