=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194981688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MVHE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2008
-----------------------------------------------------
Last Update Date | 11/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 SYCAMORE CREEK DR SUITE C
-----------------------------------------------------
City | SPRINGBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45066-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-748-4211
-----------------------------------------------------
Fax | 937-748-3566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 SYCAMORE CREEK DR SUITE C
-----------------------------------------------------
City | SPRINGBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45066-2300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-748-4211
-----------------------------------------------------
Fax | 937-748-3566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | KENNETH PRUNIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-208-8213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------