1619010535 NPI number — CENTRAL OHIO NEUROLOGY INC

Table of content: SEONG-CHEON P. KIM MD (NPI 1851468904)

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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