1760425078 NPI number — JAMES EDWARD MACKLIN MD

Table of content: JAMES EDWARD MACKLIN MD (NPI 1760425078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760425078 NPI number — JAMES EDWARD MACKLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKLIN
Provider First Name:
JAMES
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760425078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3555 OLENTANGY RIVER RD
Provider Second Line Business Mailing Address:
SUITE 3070
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43214-3912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-566-2942
Provider Business Mailing Address Fax Number:
614-566-6886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 MCNAUGHTEN ROAD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-577-8322
Provider Business Practice Location Address Fax Number:
614-577-8302
Provider Enumeration Date:
06/14/2006

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: 207RC0200X , with the licence number:  35041210 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 35041210 , 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: 0434499 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4800038 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000118566 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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