Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207R00000X | Internal Medicine | | | | No |
| 2 | 207Q00000X | Family Medicine | | | | No |
| 3 | 208600000X | Surgery | | | | No |
| 4 | 2084N0400X | Psychiatry & Neurology | Neurology | | | No |
| 5 | 208100000X | Physical Medicine & Rehabilitation | | | | No |
| 6 | 207RP1001X | Internal Medicine | Pulmonary Disease | | | No |
| 7 | 363A00000X | Physician Assistant | | | | No |
| 8 | 103T00000X | Psychologist | | | | No |
| 9 | 2086S0102X | Surgery | Surgical Critical Care | | | No |
| 10 | 207RC0000X | Internal Medicine | Cardiovascular Disease | | | No |
| 11 | 207RN0300X | Internal Medicine | Nephrology | | | No |
| 12 | 207RG0100X | Internal Medicine | Gastroenterology | | | No |
| 13 | 207Y00000X | Otolaryngology | | | | No |
| 14 | 282N00000X | General Acute Care Hospital | | | | No |
| 15 | 282E00000X | Long Term Care Hospital | | 1409 | OHIO | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 000000298165 | OTHER | OHIO | ANTHEM SKILLED NURSING |
| 2 | =========013 | OTHER | OHIO | MEDICAL MUTUAL OH ACUTE |
| 3 | =========005 | OTHER | OHIO | MEDICAL MUTUAL OH REHAB |
| 4 | 50-00175 | OTHER | OHIO | UNITED HEALTHCARE OF OHIO |
| 5 | =========03 | OTHER | OHIO | OHIO BWC SKILLED |
| 6 | 000000003166 | OTHER | OHIO | ANTHEM HOSPITAL |
| 7 | 0153828 | MEDICAID | OHIO | |
| 8 | =========00 | OTHER | OHIO | OHIO BWC HOSPITAL |
| 9 | =========009 | OTHER | OHIO | MEDICAL MUTUAL OH SKILLED |
| 10 | 2315202 | MEDICAID | OHIO | |
| 11 | 36-2004 | MEDICARE OSCAR/CERTIFICATION | OHIO | |
