Healthcare Provider Details

I. General information

NPI: 1013116409
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S MAIN ST STE 3
DAYTON OH
45409-2698
US

IV. Provider business mailing address

1520 S MAIN ST STE 3
DAYTON OH
45409-2698
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7275
  • Fax: 937-208-7282
Mailing address:
  • Phone: 937-208-7275
  • Fax: 937-208-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH J PRUNIER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 937-208-8252