Healthcare Provider Details

I. General information

NPI: 1659504785
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 KETTERING BLVD BUILDING B 3RD FLOOR
MORAINE OH
45439-1924
US

IV. Provider business mailing address

3170 KETTERING BLVD BUILDING B 3RD FLOOR
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-991-3188
  • Fax: 937-223-9811
Mailing address:
  • Phone: 937-991-3188
  • 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
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHEL DARLENE
Title or Position: SYSTEMS SUPPORT ANALYST
Credential:
Phone: 937-499-8205