Basic Information
Provider Information | |||||||||
NPI: | 1679561310 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ADKINS | ||||||||
FirstName: | EDWARD | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 715 RICHLAND MALL | ||||||||
Address2: |   | ||||||||
City: | ONTARIO | ||||||||
State: | OH | ||||||||
PostalCode: | 449063802 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4195296195 | ||||||||
FaxNumber: | 4195299187 | ||||||||
Practice Location | |||||||||
Address1: | 715 RICHLAND MALL | ||||||||
Address2: |   | ||||||||
City: | ONTARIO | ||||||||
State: | OH | ||||||||
PostalCode: | 449063802 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4195296195 | ||||||||
FaxNumber: | 4195299187 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2005 | ||||||||
LastUpdateDate: | 12/07/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/07/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35049925 | OH | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 8022484 | 01 | OH | CIGNA | OTHER | 03429 | 01 | OH | PARAMOUNT | OTHER | 0533908 | 05 | OH |   | MEDICAID | 080163105 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000179816 | 01 | OH | ANTHEM | OTHER | 0100015 | 01 | OH | UNITEDHEALTHCARE | OTHER |