1942365481 NPI number — PLYMOUTH TOWNSHIP TRUSTEES

Table of content: DR. DAVID LESLIE SURUJPAUL MD (NPI 1457039778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942365481 NPI number — PLYMOUTH TOWNSHIP TRUSTEES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLYMOUTH TOWNSHIP TRUSTEES
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:
6
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:
1942365481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 PLYMOUTH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTABULA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44004-9150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-993-4350
Provider Business Mailing Address Fax Number:
440-992-9406

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 PLYMOUTH ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHTABULA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44004-9150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-993-4350
Provider Business Practice Location Address Fax Number:
440-992-9406
Provider Enumeration Date:
12/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STEVENSON
Authorized Official First Name:
MARYANN
Authorized Official Middle Name:
Authorized Official Title or Position:
FISCAL OFFICER
Authorized Official Telephone Number:
440-993-4350

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020822300 , 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: 0232984 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000156045 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 590010165 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".