Healthcare Provider Details

I. General information

NPI: 1912310400
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N MAIN ST
CENTERVILLE OH
45459-4465
US

IV. Provider business mailing address

330 N MAIN ST
CENTERVILLE OH
45459-4465
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-0960
  • Fax: 937-433-0958
Mailing address:
  • Phone: 937-433-0960
  • Fax: 937-433-0958

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: 937-499-8205