1821105933 NPI number — PK MILLS AND COMPANY

Table of content: EUGENIE RUTH CORSON C.O.T.A. (NPI 1104135318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821105933 NPI number — PK MILLS AND COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PK MILLS AND COMPANY
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:
1821105933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 FRANKLIN AVENUE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
TORONTO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43964-1153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-537-1175
Provider Business Mailing Address Fax Number:
740-537-1992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 FRANKLIN AVENUE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
TORONTO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43964-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-537-1175
Provider Business Practice Location Address Fax Number:
740-537-1992
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
VICE PRESIDENT OPERATIONS
Authorized Official Telephone Number:
740-537-1175

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0954052 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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