1780608315 NPI number — KAISER WELLS INC

Table of content: (NPI 1780608315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780608315 NPI number — KAISER WELLS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER WELLS 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:
6
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:
1780608315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 BENEDICT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44857-2346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-668-7651
Provider Business Mailing Address Fax Number:
419-663-5837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 BENEDICT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44857-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-668-7651
Provider Business Practice Location Address Fax Number:
419-663-5837
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NESTOR
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
419-668-7651

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  HMER.22043 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3336C0003X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 03501 . This is a "PARAMOUNT HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4511335 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56129 . This is a "ABP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 56129 . This is a "NORTHWOOD NPN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000155940 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000155940 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4511335 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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