1649467119 NPI number — MIDWEST PSYCHIATRIC CENTER, INC.

Table of content: (NPI 1649467119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649467119 NPI number — MIDWEST PSYCHIATRIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST PSYCHIATRIC CENTER, 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:
1649467119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635924
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-5924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-421-3504
Provider Business Mailing Address Fax Number:
513-231-7055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7760 WEST VOA PARK DR
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45069-3371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-217-5221
Provider Business Practice Location Address Fax Number:
513-217-6221
Provider Enumeration Date:
09/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KANERIA
Authorized Official First Name:
RAKESHKUMAR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-217-5221

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35083440 , 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: 2804013 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 293747 . This is a "AMERIGROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 603986997-002 . This is a "MMOH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 603986997-00 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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