1730748708 NPI number — HEALTH PARTNERS OF WESTERN OHIO

Table of content: (NPI 1730748708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730748708 NPI number — HEALTH PARTNERS OF WESTERN OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH PARTNERS OF WESTERN OHIO
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:
1730748708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 N WEST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45801-4332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-221-3072
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1344 W SENECA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIFFIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44883-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-938-0300
Provider Business Practice Location Address Fax Number:
419-481-8743
Provider Enumeration Date:
06/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
419-221-3072

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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