Provider Demographics
NPI:1124142120
Name:IP NURSES AIDE
Entity type:Organization
Organization Name:IP NURSES AIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NONE AGENCY NURSES AIDE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-213-0567
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:BEALLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43716-0130
Mailing Address - Country:US
Mailing Address - Phone:740-213-0567
Mailing Address - Fax:
Practice Address - Street 1:123 CLARK ST
Practice Address - Street 2:
Practice Address - City:POWHATAN POINT
Practice Address - State:OH
Practice Address - Zip Code:43942-1261
Practice Address - Country:US
Practice Address - Phone:740-795-5946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2395920Medicare ID - Type Unspecified