1861413205 NPI number — ANCILLARY SERVICES MANAGEMENT, LLC

Table of content: (NPI 1861413205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861413205 NPI number — ANCILLARY SERVICES MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANCILLARY SERVICES MANAGEMENT, 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:
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:
1861413205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 NORTH SUMMIT STREET
Provider Second Line Business Mailing Address:
ATTN: APRIL TERRY
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-252-6011
Provider Business Mailing Address Fax Number:
800-375-5492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 NORTH SUMMIT STREET
Provider Second Line Business Practice Location Address:
ATTN: APRIL TERRY
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43604-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-252-6011
Provider Business Practice Location Address Fax Number:
800-375-5492
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KIGHT
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
419-252-5722

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BN1400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0747347-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9136576 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100032140A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 168228800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012206080002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0804973 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2749869 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9054925 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3714403 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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