1740276708 NPI number — DR. RUSTY L MYERS D.C.

Table of content: DR. RUSTY L MYERS D.C. (NPI 1740276708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740276708 NPI number — DR. RUSTY L MYERS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS
Provider First Name:
RUSTY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1740276708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1658 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZANESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43701-2552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-450-2225
Provider Business Mailing Address Fax Number:
740-450-2226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1658 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-2552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-450-2225
Provider Business Practice Location Address Fax Number:
740-450-2226
Provider Enumeration Date:
09/26/2005

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: 111N00000X , with the licence number:  2417 , 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: 2383899 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300022209-00 . This is a "BWC - GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311520435 . This is a "ID - INDIVIDUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311520435-00 . This is a "BWC - INDIVIDUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000225959 . This is a "ANTHEM - INDIVIDUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000225960 . This is a "ANTHEM - GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2005789 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300022209 . This is a "ID - GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 300022209001 . This is a "MEDICAL MUTUAL - GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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