1811998206 NPI number — MAPLE KNOLL COMMUNITIES INC

Table of content: CHARLES SAMUEL KUZMA M.D. (NPI 1063469856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811998206 NPI number — MAPLE KNOLL COMMUNITIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAPLE KNOLL COMMUNITIES 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:
1811998206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11100 SPRINGFIELD PIKE
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:
45246-4112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-782-2400
Provider Business Mailing Address Fax Number:
513-771-0175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6727 CONTRERAS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45056-8769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-524-7990
Provider Business Practice Location Address Fax Number:
513-524-7769
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENDRICKS
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE COMPTROLLER
Authorized Official Telephone Number:
513-782-2737

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2394N , 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: 2440308 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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