1134212004 NPI number — WILLIAM J NIEMES MD INC

Table of content: (NPI 1134212004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134212004 NPI number — WILLIAM J NIEMES MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM J NIEMES MD INC
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:
ALLERGY & ASTHMA CARE INC
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:
1134212004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 RAY NORRISH DR # 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-1520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-671-0799
Provider Business Mailing Address Fax Number:
513-671-0845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 RAY NORRISH DR # 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45246-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-671-0799
Provider Business Practice Location Address Fax Number:
513-671-0845
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCHER
Authorized Official First Name:
SALLY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
513-671-0799

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  35.093000 , 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: DF5846 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100256520A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 643419 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 928184 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000008215 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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