1881694289 NPI number — JOHN ROSS MD

Table of content: JOHN ROSS MD (NPI 1881694289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881694289 NPI number — JOHN ROSS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1881694289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 VAN BUREN ST
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
FOSTORIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44830-1593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-435-4950
Provider Business Mailing Address Fax Number:
419-435-0849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 VAN BUREN ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
FOSTORIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44830-1593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-435-4950
Provider Business Practice Location Address Fax Number:
419-435-0849
Provider Enumeration Date:
07/28/2005

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: 207V00000X , with the licence number:  35064459 , 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: 14-10282 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 282548894-009 . This is a "MMOH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4557221 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 01984 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0914032 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000295676 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 160060037 . This is a "RRMC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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