1902979453 NPI number — PERRY KALIS M.D. INC

Table of content: (NPI 1902979453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902979453 NPI number — PERRY KALIS M.D. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRY KALIS M.D. 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:
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:
1902979453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 NORTH MAYSVILLE AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SOUTH ZANESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43701-7507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-588-0008
Provider Business Mailing Address Fax Number:
740-588-0143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 NORTH MAYSVILLE AVENUE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SOUTH ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-588-0008
Provider Business Practice Location Address Fax Number:
740-588-0143
Provider Enumeration Date:
11/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KALIS
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-588-0008

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35038121K , 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: 210780 . This is a "NATIONWIDE INSURANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0404062 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 235727435003 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000122256 . This is a "ANTHEM INDIVIDUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000162736 . This is a "ANTHEM-GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2056028 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000217078 . This is a "ANTHEM-LAB" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6952646002 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 23572743500 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: M38121A . This is a "HEALTH PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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