1790101681 NPI number — AMERICAN HEALTH MW, LLC

Table of content: (NPI 1790101681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790101681 NPI number — AMERICAN HEALTH MW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HEALTH MW, LLC
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:
1790101681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
671 OHIO PIKE STE K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45245-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-528-8832
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
665 OHIO PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45245-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-522-7556
Provider Business Practice Location Address Fax Number:
877-320-1186
Provider Enumeration Date:
03/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-919-5005

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1032642840001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1790101681 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201272540A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36D0338636 . This is a "CLIA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1790101681 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26D0440143 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 36D0346978 . This is a "CLIA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0108856 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18D1080513 . This is a "CLIA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 36D0904468 . This is a "CLIA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 23D2045786 . This is a "CLIA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1790101681 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100367060 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14D0419196 . This is a "CLIA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 15D2047655 . This is a "CLIA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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