1033140785 NPI number — MRS. SHIXI CHEN OMD

Table of content: MRS. SHIXI CHEN OMD (NPI 1033140785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033140785 NPI number — MRS. SHIXI CHEN OMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEN
Provider First Name:
SHIXI
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OMD
Provider Gender Code:
F

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:
1033140785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4610 SAWMILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43220-2247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-538-0983
Provider Business Mailing Address Fax Number:
614-538-0989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 SAWMILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43220-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-538-0983
Provider Business Practice Location Address Fax Number:
614-538-0989
Provider Enumeration Date:
07/05/2006

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: 171100000X , with the licence number:  65. 000004 , 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: 118330 . This is a "NATIONWIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 31-1816317 . This is a "NGS AMERICAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311816317 . This is a "UNICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311816317-00 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311816317-0000 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 311816317 . This is a "HUMANA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 23-00545 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 00070977374 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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