1770567661 NPI number — MR. JASON RAABE PA-C

Table of content: MR. JASON RAABE PA-C (NPI 1770567661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770567661 NPI number — MR. JASON RAABE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAABE
Provider First Name:
JASON
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-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:
1770567661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
457 THORBURN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-6847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-961-9958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 W MCCREIGHT AVE STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-523-9820
Provider Business Practice Location Address Fax Number:
937-523-9829
Provider Enumeration Date:
12/03/2005

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: 363AS0400X , with the licence number:  50002026 , 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: 373855 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com