1992760474 NPI number — MARK KISSINGER DO

Table of content: MARK KISSINGER DO (NPI 1992760474)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992760474 NPI number — MARK KISSINGER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KISSINGER
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1992760474
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 SUMMIT AVE
Provider Second Line Business Mailing Address:
MSO PHYSICIAN BILLING
Provider Business Mailing Address City Name:
STEUBENVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43952-2667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-283-7597
Provider Business Mailing Address Fax Number:
740-283-7190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43953-3733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-264-1656
Provider Business Practice Location Address Fax Number:
740-266-2936
Provider Enumeration Date:
04/19/2006

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: 207Q00000X , with the licence number:  34007545 , 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: 2350861 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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