1912179508 NPI number — WILLIAM JEREMY HARVEY

Table of content: (NPI 1912179508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912179508 NPI number — WILLIAM JEREMY HARVEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM JEREMY HARVEY
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:
TRI-STATE HOME MEDICAL
Provider Other Organization Name Type Code:
3
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:
1912179508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1409 US ROUTE 35 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45320-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-472-3335
Provider Business Mailing Address Fax Number:
937-472-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1409 US ROUTE 35 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45320-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-472-3335
Provider Business Practice Location Address Fax Number:
937-472-3332
Provider Enumeration Date:
03/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
JEREMY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-472-3335

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  HMER.22478 , 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: 200897400A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2834133 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".