1710179775 NPI number — DR. GAIL J RYMER PHD

Table of content: DR. GAIL J RYMER PHD (NPI 1710179775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710179775 NPI number — DR. GAIL J RYMER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYMER
Provider First Name:
GAIL
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

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:
1710179775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 373
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELPRE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45714-0373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-423-4743
Provider Business Mailing Address Fax Number:
740-423-4248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1085 JOE SKINNER RD 51
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELPRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45714-9488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-423-4743
Provider Business Practice Location Address Fax Number:
740-423-4248
Provider Enumeration Date:
08/14/2007

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: 103T00000X , with the licence number:  477 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 4026 , 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: 063302000 . This is a "MAGELLAN BEHAV HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000119302 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0736501 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620004171 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0163293000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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