Healthcare Provider Details

I. General information

NPI: 1205138872
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N FAIRFIELD RD SUITE 110
BEAVERCREEK OH
45432-2762
US

IV. Provider business mailing address

1911 N FAIRFIELD RD SUITE 110
BEAVERCREEK OH
45432-2762
US

V. Phone/Fax

Practice location:
  • Phone: 937-429-1369
  • Fax: 937-429-4575
Mailing address:
  • Phone: 937-429-1369
  • Fax: 937-429-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 937-208-8213