Basic Information
Provider Information | |||||||||
NPI: | 1699914481 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | EVANT INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2251 FRONT ST | ||||||||
Address2: | SUITE 200 | ||||||||
City: | CUYAHOGA FALLS | ||||||||
State: | OH | ||||||||
PostalCode: | 442212567 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3309201517 | ||||||||
FaxNumber: | 3309201016 | ||||||||
Practice Location | |||||||||
Address1: | 4223 ELLSWORTH RD | ||||||||
Address2: |   | ||||||||
City: | STOW | ||||||||
State: | OH | ||||||||
PostalCode: | 442242205 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3309296506 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/18/2009 | ||||||||
LastUpdateDate: | 02/18/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GEDEON | ||||||||
AuthorizedOfficialFirstName: | SHERRY | ||||||||
AuthorizedOfficialMiddleName: | D. | ||||||||
AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3309201517 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | 7710294 | OH | Y |   | Agencies | Voluntary or Charitable |   |
No ID Information.