1821080243 NPI number — MR. JEFFREY E MOLTER C.R.N.A.

Table of content: MR. JEFFREY E MOLTER C.R.N.A. (NPI 1821080243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821080243 NPI number — MR. JEFFREY E MOLTER C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLTER
Provider First Name:
JEFFREY
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
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:
1821080243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10335 PINECREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD TWP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44077-8814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-478-8448
Provider Business Mailing Address Fax Number:
440-478-8448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 MEDICAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FINDLAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45840-1398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-429-0409
Provider Business Practice Location Address Fax Number:
419-429-0410
Provider Enumeration Date:
08/22/2005

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: 367500000X , with the licence number:  248071 , 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: 2191855 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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