1619010535 NPI number — CENTRAL OHIO NEUROLOGY INC

Table of content: (NPI 1619010535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619010535 NPI number — CENTRAL OHIO NEUROLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO NEUROLOGY 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:
1619010535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 CLINE AVE
Provider Second Line Business Mailing Address:
STE C5
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44907-1057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-756-6990
Provider Business Mailing Address Fax Number:
419-756-0944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 CLINE AVENUE
Provider Second Line Business Practice Location Address:
STE C5
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44907-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-756-6990
Provider Business Practice Location Address Fax Number:
419-756-0944
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BADDOUR
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
419-756-6990

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2877801 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 606176800 . This is a "DEPT OF LABOR ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 30022664 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000182209 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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