Healthcare Provider Details

I. General information

NPI: 1154376242
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 CLYO RD SUITE A
CENTERVILLE FINANCE OH
45459-2786
US

IV. Provider business mailing address

6611 CLYO RD SUITE A
CENTERVILLE OH
45459-2786
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7300
  • Fax: 937-208-7330
Mailing address:
  • Phone: 937-208-7300
  • Fax: 937-208-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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