1912125204 NPI number — DR. KRISTOPHER REED FISHER M.D.

Table of content: TINA BAIRD (NPI 1669224648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912125204 NPI number — DR. KRISTOPHER REED FISHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
KRISTOPHER
Provider Middle Name:
REED
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1912125204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 COUNTRY LINE RD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-7294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-847-4100
Provider Business Mailing Address Fax Number:
614-430-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 W. SCHROCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43081-2874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-895-0400
Provider Business Practice Location Address Fax Number:
614-895-2911
Provider Enumeration Date:
04/23/2007

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: 207N00000X , with the licence number:  44888 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 32355 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0900X , with the licence number: 35137423 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 44888 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0900X , with the licence number: 44888 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003181475A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184357 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07820719 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912125204 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 186863001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0388256 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1523453 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".