Basic Information
Provider Information | |||||||||
NPI: | 1639131501 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TICE | ||||||||
FirstName: | FRANK | ||||||||
MiddleName: | D | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | IV | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2570 ABINGTON RD | ||||||||
Address2: |   | ||||||||
City: | UPPER ARLINGTON | ||||||||
State: | OH | ||||||||
PostalCode: | 432213004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6144867165 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 745 W STATE ST | ||||||||
Address2: | STE 750 | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432221515 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6142242281 | ||||||||
FaxNumber: | 6142218869 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/05/2006 | ||||||||
LastUpdateDate: | 05/30/2008 | ||||||||
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 | 207RC0000X | 35056291T | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 2500396 | 01 |   | UNITED HEALTHCARE | OTHER | 00000000014654 | 01 |   | ANTHEM BCBS | OTHER | 060038976 | 01 |   | RAILROAD MEDICARE | OTHER | 10600 | 01 |   | NATIONWIDE | OTHER | 289254 | 01 |   | BLACK LUNG | OTHER | 9721935 | 01 |   | CIGNA | OTHER | 0761126 | 05 | OH |   | MEDICAID |