1962543470 NPI number — MR. RONALD E HANEY LISW-SUPV

Table of content: MR. RONALD E HANEY LISW-SUPV (NPI 1962543470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962543470 NPI number — MR. RONALD E HANEY LISW-SUPV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANEY
Provider First Name:
RONALD
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LISW-SUPV
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:
1962543470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3095 KETTERING BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1983
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-294-4623
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3095 KETTERING BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45439-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-293-8300
Provider Business Practice Location Address Fax Number:
937-534-1350
Provider Enumeration Date:
02/08/2007

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: 104100000X , with the licence number:  I5621 , 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)





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