NPI |
1881297240 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Entity Type Code |
1 |
The first name of the provider, if the provider
is an individual. |
Provider Last Name Legal Name |
STONE |
The middle name of the provider, if the provider
is an individual. |
Provider First Name |
JUANA |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Middle Name |
K. |
The city name in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
892 BELDEN AVE |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address City Name |
AKRON |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address State Name |
OH |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
443101741 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The fax number associated with the location
address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3306340969 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Enumeration Date |
11/18/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/18/2020 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
253Z00000X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
253Z00000X |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
OH |
|
Is Sole Proprietor |
Y |
|
NPI Certification Date |
11/18/2020 |
|