=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083422760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMUEL MUETZEL
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2024
-----------------------------------------------------
Last Update Date | 12/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8535 TOWNSHIP ROAD 36 NW
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43783-9593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-877-0157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8535 TOWNSHIP ROAD 36 NW
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43783-9593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------