Provider Demographics
NPI:1104832476
Name:NICK GHAPHERY LLC
Entity Type:Organization
Organization Name:NICK GHAPHERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GHAPHERY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-671-1291
Mailing Address - Street 1:106 PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950
Mailing Address - Country:US
Mailing Address - Phone:740-296-5529
Mailing Address - Fax:740-296-5160
Practice Address - Street 1:106 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950
Practice Address - Country:US
Practice Address - Phone:740-296-5529
Practice Address - Fax:740-296-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006290207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9362561Medicare PIN
WV9362571Medicare PIN