1740032275 NPI number — AUSTIN LOUIS COLDSNOW MSPAS

Table of content: AUSTIN LOUIS COLDSNOW MSPAS (NPI 1740032275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740032275 NPI number — AUSTIN LOUIS COLDSNOW MSPAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLDSNOW
Provider First Name:
AUSTIN
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPAS
Provider Gender Code:
M

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:
1740032275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4620 BRIAR HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAVENNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44266-7846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-592-4604
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1790 GRAYBILL RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44685-7993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
234-312-2111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2024

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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