1619953742 NPI number — DR. PAUL J OPSAHL MD

Table of content: DR. PAUL J OPSAHL MD (NPI 1619953742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619953742 NPI number — DR. PAUL J OPSAHL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPSAHL
Provider First Name:
PAUL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1619953742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2912 SPRINGBORO W
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-897-0085
Provider Business Mailing Address Fax Number:
513-897-0194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4353 E STATE ROUTE 73 STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45068-8814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-897-0085
Provider Business Practice Location Address Fax Number:
513-897-0194
Provider Enumeration Date:
12/20/2005

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: 207Q00000X , with the licence number:  35047593 , 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: 000000227901 . This is a "UNICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 080188829 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 35047593 . This is a "MEDICAL LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0527497 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 421534506034 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 634298 . This is a "AETNA" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: OC05219 . This is a "NATIONWIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0120625 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 000000227901 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4759302 . This is a "HUMANA/CHOICECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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