NPI Record of VEIN CLINICS OF LAKE COUNTY LLC NPI 1073947867

Internal Medicine in Painesville, OH

Complete NPI Record

Field Name Value Definition
NPI1073947867The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameVEIN CLINICS OF LAKE COUNTY LLCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address7580 AUBURN RDThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressSTE 214The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NamePAINESVILLEThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameOHThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code440779615The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number4403522702The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number4402522700The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address7580 AUBURN RDThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSTE 214The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePAINESVILLEThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameOHThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code440779615The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number4403522702The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4402522700The fax number associated with the location address of the provider being identified.
Provider Enumeration Date8/28/2013The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date8/28/2013The date that a record was last updated or changed.
Authorized Official Last NameGIORDONThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameMACHELLEThe first name of the authorized official.
Authorized Official Title or PositionCREDENTIALINGThe title or position of the authorized official.
Authorized Official Telephone Number3307232111The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1207R00000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 135074946The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1OHThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Healthcare Provider Taxonomy Group 1193400000X SINGLE SPECIALTY GROUP