Healthcare Provider Details

I. General information

NPI: 1912935545
Provider Name (Legal Business Name): BRENT CHARLES NIMETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 YAUGER RD
MOUNT VERNON OH
43050-9233
US

IV. Provider business mailing address

KNOX COMMUNITY HOSPITAL DEPARTMENT OF PRIMARY CARE / FAMILY MEDICINE
MOUNT VERNON OH
43050-9233
US

V. Phone/Fax

Practice location:
  • Phone: 740-263-7036
  • Fax: 740-399-3753
Mailing address:
  • Phone: 740-393-9000
  • Fax: 740-392-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.058819
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: