Provider Demographics
NPI:1174631725
Name:MVHE INC
Entity Type:Organization
Organization Name:MVHE INC
Other - Org Name:WALDEN PONDS PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8213
Mailing Address - Street 1:5971 GOLF CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8200
Mailing Address - Country:US
Mailing Address - Phone:513-785-4339
Mailing Address - Fax:513-785-4338
Practice Address - Street 1:5971 GOLF CLUB LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-8200
Practice Address - Country:US
Practice Address - Phone:513-785-4339
Practice Address - Fax:513-785-4338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MVHE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2813389Medicaid
OH2813389Medicaid