1689645558 NPI number — DASCO HME, LLC

Table of content: (NPI 1689645558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689645558 NPI number — DASCO HME, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DASCO HME, LLC
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:
6
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:
1689645558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 N WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-901-2226
Provider Business Mailing Address Fax Number:
614-901-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1656 EAGLE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44805-8924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-289-6489
Provider Business Practice Location Address Fax Number:
419-289-6506
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAZUR
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
614-901-2226

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  22187 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 02-1063550 , 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: 000000018640 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0172426 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 381880001 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57223 . This is a "NORTHWOODS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0172487 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 479343 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1057542 . This is a "WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1361859 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".




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