WMK, LLC
Complete NPI Record 1295858736
Contractor - Vehicle Modifications in Akron, OH

Active since April 09, 2007

810 MOE DR, AKRON, OH 44310(330) 633-1118 Get Directions

NPPES record last updated: February 27, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 8, 2025, Jul 12, 2024, Nov 3, 2023 and 12 more (15 updates tracked since 2017).

Complete NPI Dataset

This page contains the complete raw NPPES record for Wmk, Llc (NPI 1295858736), a contractor organization in Akron, OH. All 78 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

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Registry File Document Utilities

NPI: 1295858736: The 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 Code: 2: Code 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 EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: WMK, LLC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: 4199 KINROSS LAKES PKWY STE 300: The 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 Address: ATTN: COMPLIANCE: The 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 Name: RICHFIELD: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OH: The 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 Code: 442869394: The 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 : US: The 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 Number: 2342001382: The 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 Number: 3306590876: The 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 Address: 810 MOE DR: The 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 Business Practice Location Address City Name: AKRON: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OH: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 443102517: The 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 : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3306331118: The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 4/9/2007: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 2/27/2026: The date that a record was last updated or changed.
Authorized Official Last Name: MALOTT: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MEGAN: The first name of the authorized official.
Authorized Official Title or Position: COMPLIANCE MANAGER: The title or position of the authorized official.
Authorized Official Telephone Number: 2342001382: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 332BC3200X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 2: 171WH0202X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 2: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 3: 332B00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 3: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 4: 171WV0202X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 4: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Other Provider Identifier 1: 1295858736: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 1: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 1: IA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 2: 250589236: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 2: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 2: DE: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 3: 300082172: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 3: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 3: IN: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 4: 3749376: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 4: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 4: TX: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 5: 47737414: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 5: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 5: NE: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 6: 3795882: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 6: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 6: TX: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 7: ERS19925001: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 7: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 7: MO: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 8: 103424092: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 8: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 8: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 9: 3804114: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 9: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 9: TX: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 10: 7718871: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 10: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 10: OH: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 11: 1821257064: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 11: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 11: TX: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 12: 2084775: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 12: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 12: OH: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 13: 3801946: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 13: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 13: TX: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 14: S500565660: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 14: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 14: TX: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Is Organization Subpart: N: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
NPI Certification Date: 2/27/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Secondary Practice Locations 48

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

6473 De Zavala Rd

1/48

San Antonio, TX 78249-2343 · Phone (210) 697-8884 · Fax (210) 697-8377

4025 Queen City Dr

2/48

Charlotte, NC 28208-3509 · Phone (704) 399-0900 · Fax (704) 399-9009

3560 Sheridan Dr

3/48

Buffalo, NY 14226-1630 · Phone (716) 342-3530

1012 Seco Rd

4/48

Monroeville, PA 15146-1448 · Phone (412) 824-8091 · Fax (412) 824-1996

21704 87th Ave SE

5/48

Woodinville, WA 98072-8017 · Phone (425) 481-6546

6053 Tacoma Mall Blvd

6/48

Tacoma, WA 98409-6826 · Phone (253) 267-5280

1770 W 81st Ave

7/48

Merrillville, IN 46410-5349 · Phone (219) 796-0700

4044 S 60th St

8/48

Omaha, NE 68117-1220 · Phone (402) 313-3377

3327 S Sam Houston Pkwy E

9/48

Houston, TX 77047-6548 · Phone (346) 226-6998 · Fax (346) 226-6997

1766 Hammond St

10/48

Hermon, ME 04401-1119 · Phone (207) 848-8226

80 E Jefryn Blvd

11/48

Deer Park, NY 11729-5755 · Phone (631) 254-4031

3115 Oak Knoll Dr

12/48

Eau Claire, WI 54701-8485 · Phone (715) 495-1310

844 Ontario Rd

13/48

Green Bay, WI 54311-8018 · Phone (920) 491-8384

5460 Campbells Run Rd

14/48

Pittsburgh, PA 15205-1026 · Phone (412) 799-6929

2110 N Beach St

15/48

Fort Worth, TX 76111-6812 · Phone (817) 429-1273

1640 S Abilene St

16/48

Aurora, CO 80012-5872 · Phone (702) 722-2680 · Fax (702) 269-4283

9675 S Compass Dr

17/48

Rossford, OH 43460-1740 · Phone (419) 476-4890

3575 W Cheyenne Ave Ste 105

18/48

North Las Vegas, NV 89032-8259 · Phone (702) 876-9606

137 Trans Air Dr

19/48

Morrisville, NC 27560-7211 · Phone (919) 296-8587

239 Commercial Dr

20/48

Buda, TX 78610-3525 · Phone (866) 211-8267

3450 SE Miehe Dr Ste 1

21/48

Grimes, IA 50111-6662 · Phone (515) 448-2020

68 E 3300 S

22/48

South Salt Lake, UT 84115-3710 · Phone (801) 487-0111

4150 Interstate 30

23/48

Mesquite, TX 75150-2058 · Phone (972) 270-7114

23855 W Andrew Rd

24/48

Plainfield, IL 60585-9588 · Phone (815) 254-2000

1115 SW Oldham Pkwy

25/48

Lees Summit, MO 64081-2477 · Phone (816) 600-5124

9207 N Milwaukee Ave

26/48

Niles, IL 60714-1301 · Phone (847) 673-4300

299 Washington St Ste H

27/48

Woburn, MA 01801-2793 · Phone (339) 220-3856

5751 General Washington Dr Ste D

28/48

Alexandria, VA 22312-2418 · Phone (571) 765-3646

N8W22195 Johnson Dr Ste 130

29/48

Waukesha, WI 53186-1809 · Phone (262) 574-0970

7450 Midlothian Tpke

30/48

North Chesterfield, VA 23225-5419 · Phone (804) 220-0611

3418 Main St Ste 400

31/48

Bryant, AR 72022-6001 · Phone (501) 500-9393

7434 E 46th St

32/48

Tulsa, OK 74145-6302 · Phone (918) 622-8400

1892 Central Ave Ste 25

33/48

Albany, NY 12205-4200 · Phone (518) 346-9059

9740 SW Wilsonville Rd Ste 250

34/48

Wilsonville, OR 97070-7754 · Phone (971) 224-5895

4199 Kinross Lakes Pkwy Ste 300

35/48

Richfield, OH 44286-9394 · Phone (234) 312-2000

11755 Mosteller Rd

36/48

Sharonville, OH 45241-5505 · Phone (513) 791-4000

200 E 1st St

37/48

Tea, SD 57064-2297 · Phone (605) 498-2200

5040 Richmond Rd

38/48

Bedford, OH 44146-1329 · Phone (440) 951-4335

214 Valley St

39/48

Dayton, OH 45404-1839 · Phone (937) 222-5001 · Fax (937) 222-4001

7233 Industrial Pkwy

40/48

Plain City, OH 43064-8728 · Phone (614) 873-1580 · Fax (614) 873-1589

211 Woodbridge Ave

41/48

Highland Park, NJ 08904-3701 · Phone (732) 640-5342

16262 Ih 35 N

42/48

Selma, TX 78154-1212 · Phone (210) 718-0055

1604 E 14 Mile Rd

43/48

Madison Heights, MI 48071-1505 · Phone (248) 616-3004

1915 County Road C W

44/48

Roseville, MN 55113-1320 · Phone (651) 364-7600

4012 Dearborn Pl NW

45/48

Concord, NC 28027-4624 · Phone (866) 593-2048

155 E North Ave

46/48

Villa Park, IL 60181-1227 · Phone (630) 782-1900

5105 New Jersey Route 33

47/48

Wall Township, NJ 07727-4003 · Phone (732) 751-4524

1010 Contractors Way

48/48

Bear, DE 19701-5211 · Phone (302) 613-7555

Other Provider Identifiers 14

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

1295858736 Medicaid

1/14

State: IA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

250589236 Medicaid

2/14

State: DE
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

300082172 Medicaid

3/14

State: IN
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

3749376 Medicaid

4/14

State: TX
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

47737414 Medicaid

5/14

State: NE
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

3795882 Medicaid

6/14

State: TX
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

ERS19925001 Medicaid

7/14

State: MO
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

103424092 Medicaid

8/14

State: PA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

3804114 Medicaid

9/14

State: TX
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

7718871 Medicaid

10/14

State: OH
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

1821257064 Medicaid

11/14

State: TX
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

2084775 Medicaid

12/14

State: OH
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

3801946 Medicaid

13/14

State: TX
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

S500565660 Medicaid

14/14

State: TX
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

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