1598889651 NPI number — RICHARD D WOLFF, DPM INC

Table of content: (NPI 1598889651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598889651 NPI number — RICHARD D WOLFF, DPM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD D WOLFF, DPM 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:
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:
1598889651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 ISAAC STREETS DR
Provider Second Line Business Mailing Address:
SUITE 133
Provider Business Mailing Address City Name:
OREGON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43616-3291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-693-0055
Provider Business Mailing Address Fax Number:
419-693-5025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 ISAAC STREETS DR
Provider Second Line Business Practice Location Address:
SUITE 133
Provider Business Practice Location Address City Name:
OREGON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43616-3291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-693-0055
Provider Business Practice Location Address Fax Number:
419-693-5025
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOLFF
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-693-0055

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36.003380 , 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: 2843801 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD8905 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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