MEDICARE: MVHE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740233279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MVHE INC

Provider Business Mailing Address
First Line	:	2180 GATEWAY DR
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-6356
Country	:	US
Telephone Number	:	937-208-8155
Fax Number	:	937-208-8140

Provider Business Practice Location Address
First Line	:	2180 GATEWAY DR
Second Line	:
City	:	FAIRBORN
State	:	OH
Zip	:	45324-6356
Country	:	US
Telephone Number	:	937-208-8155
Fax Number	:	937-208-8140

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	KENNETH PRUNIER
Credential	:
Telephone Number	:	937-208-8213

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/06/2013

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Directions to “MVHE INC ” Practice Location

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