1750360814 NPI number — ABC MOBILITY OF NE OHIO, INC

Table of content: DR. CONWAY YEE SC.D., M.D. (NPI 1427091966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750360814 NPI number — ABC MOBILITY OF NE OHIO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC MOBILITY OF NE OHIO, INC
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:
1750360814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 E WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAGRIN FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44022-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-339-5255
Provider Business Mailing Address Fax Number:
440-338-5014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
539 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAGRIN FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44022-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-339-5255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARSON
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-339-5255

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  NONE REQUIRED ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0775237 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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