1598899841 NPI number — JEFFREY MP SIMINOVITCH MD INC

Table of content: (NPI 1598899841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598899841 NPI number — JEFFREY MP SIMINOVITCH MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY MP SIMINOVITCH MD 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:
1598899841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 MENTOR AVE
Provider Second Line Business Mailing Address:
SUITE 370
Provider Business Mailing Address City Name:
MENTOR
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44060-8713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-946-4555
Provider Business Mailing Address Fax Number:
440-357-5353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 MENTOR AVE
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
MENTOR
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44060-8713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-946-4555
Provider Business Practice Location Address Fax Number:
440-357-5353
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIMINOVITCH
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
M.P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-946-4555

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  35044819 , 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: 0738054 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23781 . This is a "FWJ QUALCHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0450695 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 298787415001 . This is a "FWJ MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2410448 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000133826 . This is a "LHW ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000133827 . This is a "JMPS ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00005368 . This is a "FWJ RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000309743 . This is a "FWJ ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 05084 . This is a "FWJ UNKNOWN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 340018529 . This is a "LHW RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: CH4740 . This is a "RAILROAD GRP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1901072 . This is a "FWJ UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 340000044 . This is a "JMPS RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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