Provider Demographics
NPI:1861451544
Name:ISABELLA HAMMONDS ESTATE
Entity type:Organization
Organization Name:ISABELLA HAMMONDS ESTATE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HAENGGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-278-9966
Mailing Address - Street 1:3510 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2401
Mailing Address - Country:US
Mailing Address - Phone:937-278-9966
Mailing Address - Fax:937-277-0286
Practice Address - Street 1:3510 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2401
Practice Address - Country:US
Practice Address - Phone:937-278-9966
Practice Address - Fax:937-277-0286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHN/A IN OHIO335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0005341067OtherAETNA PROVIDER NUMBER
OH0539975Medicaid
OH000000028420OtherANTHEM PROVIDER NUMBER
OH82-20259OtherUNITED HEALTH CARE
OH83027OtherNORTHWOOD NPN
OH83027OtherNORTHWOOD NPN