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KOOBY MEDICAL SUPPLIES LLC
Complete NPI Record 1780496695
Home Health in West Chester, OH

NPI Status: Active since January 27, 2025

Contact Information

7399 LAKE PARK DR
WEST CHESTER, OH
ZIP 45069
Phone: (937) 610-6545

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider First Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Is Organization Subpart
  28. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1780496695. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1780496695
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: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: UNAVAIL
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 6
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 7399 LAKE PARK DR
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 Business Mailing Address City Name: WEST CHESTER
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: 450692636
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: 9376106545
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 First Line Business Practice Location Address: 7399 LAKE PARK 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: WEST CHESTER
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: 450692636
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: 9376106545
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 1/27/2025
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 7/30/2025
The date that a record was last updated or changed.
Authorized Official Last Name: MUSTAPHA
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: AYSHIA
The first name of the authorized official.
Authorized Official Title or Position: CO-OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 9376106545
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 251E00000X
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: 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.
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.
NPI Certification Date: 7/30/2025
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.