Basic Information
Provider Information | |||||||||
NPI: | 1306849823 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GEBHART | ||||||||
FirstName: | RICK | ||||||||
MiddleName: | W | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 PRESTIGE PL STE 550 | ||||||||
Address2: |   | ||||||||
City: | MIAMISBURG | ||||||||
State: | OH | ||||||||
PostalCode: | 453426115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9376190050 | ||||||||
FaxNumber: | 9376190069 | ||||||||
Practice Location | |||||||||
Address1: | 505 CORPORATE CENTER DR | ||||||||
Address2: |   | ||||||||
City: | VANDALIA | ||||||||
State: | OH | ||||||||
PostalCode: | 453771167 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9376190050 | ||||||||
FaxNumber: | 9376190069 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/30/2005 | ||||||||
LastUpdateDate: | 01/24/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34005782 | OH | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 23334 | 01 | OH | NATIONWIDE HEALTH PLAN | OTHER | D0578203 | 01 | OH | HUMANA/CHOICECARE | OTHER | 0122721 | 01 | OH | UNITED HEALTHCARE | OTHER | 080191701 | 01 | OH | RAILROAD MEDICARE | OTHER | 0938249 | 05 | OH |   | MEDICAID | 2192769 | 01 | OH | AETNA | OTHER | 302622980900 | 01 | OH | OHIO BWC | OTHER | 000000227856 | 01 | OH | ANTHEM | OTHER | 147240004 | 01 | OH | CARESOURCE | OTHER | 34005782 | 01 | OH | MEDICAL LICENSE | OTHER |