Healthcare Provider Details

I. General information

NPI: 1194981688
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SYCAMORE CREEK DR SUITE C
SPRINGBORO OH
45066-2300
US

IV. Provider business mailing address

5 SYCAMORE CREEK DR SUITE C
SPRINGBORO OH
45066-2300
US

V. Phone/Fax

Practice location:
  • Phone: 937-748-4211
  • Fax: 937-748-3566
Mailing address:
  • Phone: 937-748-4211
  • Fax: 937-748-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 937-208-8213