1760489413 NPI number — STEPHEN GERALD WYCHOCK P.T.

Table of content: LAQUITA BILLINGSLEY (NPI 1720608243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760489413 NPI number — STEPHEN GERALD WYCHOCK P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYCHOCK
Provider First Name:
STEPHEN
Provider Middle Name:
GERALD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1760489413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
05/02/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTABULA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44004-3262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-964-2035
Provider Business Mailing Address Fax Number:
440-964-0699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHTABULA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44004-3262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-964-2035
Provider Business Practice Location Address Fax Number:
440-964-0699
Provider Enumeration Date:
07/07/2005

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: 225100000X , with the licence number:  PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251E1200X , with the licence number: PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251G0304X , with the licence number: PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251H1200X , with the licence number: PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251N0400X , with the licence number: PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X , with the licence number: PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: PT-6573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P-12042976 . This is a "MULTIPLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2160561 . This is a "FIRST HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2361699 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233508 . This is a "HEALTH AMERICA HEALTH ASS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: WY756076 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000320301 . This is a "ANTHEM BC/BS GROUP#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000320302 . This is a "ANTHEM BC/BS IND#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200346640-00 . This is a "WORKERS' COMP GROUP#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com