1689716565 NPI number — TINA JOYCE DO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689716565 NPI number — TINA JOYCE DO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TINA JOYCE DO 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:
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:
1689716565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8007 AUBURN RD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
PAINESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077-9600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-375-5520
Provider Business Mailing Address Fax Number:
440-350-0955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8007 AUBURN RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
PAINESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44077-9600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-375-5520
Provider Business Practice Location Address Fax Number:
440-375-5520
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOYCE
Authorized Official First Name:
TINA MARIE
Authorized Official Middle Name:
TRZASKA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-375-5520

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  34-008375 , 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: 1316907827 . This is a "NPI TINA JOYCE DO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2631567 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1124114731 . This is a "NPI MICHELE KLINE NP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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