=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841243862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MVHE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 11/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3038 OLIVE RD
-----------------------------------------------------
City | TROTWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45426-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-208-7050
-----------------------------------------------------
Fax | 937-208-7031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3038 OLIVE RD
-----------------------------------------------------
City | TROTWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45426-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-208-7050
-----------------------------------------------------
Fax | 937-208-7031
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------