Healthcare Provider Details

I. General information

NPI: 1033559844
Provider Name (Legal Business Name): MVHE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OVERBROOK DR STE C
MONROE OH
45050-1147
US

IV. Provider business mailing address

20 OVERBROOK DR STE C
MONROE OH
45050-1147
US

V. Phone/Fax

Practice location:
  • Phone: 937-499-8273
  • Fax: 937-223-9811
Mailing address:
  • Phone: 937-499-8273
  • Fax: 937-223-9811

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: 937-499-6762