Provider Demographics
NPI:1760681712
Name:MVHE INC
Entity type:Organization
Organization Name:MVHE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8213
Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:STE #210
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2684
Mailing Address - Country:US
Mailing Address - Phone:937-208-9090
Mailing Address - Fax:937-208-9075
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:STE #210
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-208-9090
Practice Address - Fax:937-208-9075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MVHE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-11
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2777482Medicaid
OH9187611Medicare PIN
OH2777482Medicaid