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General NPI Number Information
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NPI Number | 1679135420
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Entity Type | Organization
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Legal Business Name | PAI PARTICIPANT 9 PA
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 08/02/2025
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Provider Practice Location Address
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Address Line | 1373 N AVENUE C
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City | ELGIN
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State | TX
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Zip | 78621-1528
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Country | US
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Telephone | 512-285-2457
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 639676
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City | CINCINNATI
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State | OH
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Zip | 45263-9676
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Country | US
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Telephone | 859-291-4800
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | JILL FORD
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Credential |
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Telephone | 859-291-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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