Healthcare Provider Details

I. General information

NPI: 1104879097
Provider Name (Legal Business Name): MVHE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ELVA CT
VANDALIA OH
45377-1875
US

IV. Provider business mailing address

55 ELVA CT
VANDALIA OH
45377-1875
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7500
  • Fax: 937-208-7515
Mailing address:
  • Phone: 937-208-7500
  • Fax: 937-208-7515

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: PRESIDENT/CEO
Credential:
Phone: 937-208-8213