Basic Information
Provider Information | |||||||||
NPI: | 1780745794 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAMIREZ | ||||||||
FirstName: | JOSE | ||||||||
MiddleName: | ANGEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RAMIREZ | ||||||||
OtherFirstName: | JOSE | ||||||||
OtherMiddleName: | ANGEL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 16704 CHARLESTON PIKE | ||||||||
Address2: |   | ||||||||
City: | KINGSTON | ||||||||
State: | OH | ||||||||
PostalCode: | 456449584 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407731141 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 17273 ST RT 104 | ||||||||
Address2: | VAMC | ||||||||
City: | CHILLICOTHE | ||||||||
State: | OH | ||||||||
PostalCode: | 45601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7407731141 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2006 | ||||||||
LastUpdateDate: | 06/03/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 13954 | PR | N |   | Hospitals | Psychiatric Hospital |   | 283Q00000X | 13945 | OH | Y |   | Hospitals | Psychiatric Hospital |   |
No ID Information.