Provider Demographics
NPI:1316376643
Name:MVHE INC
Entity Type:Organization
Organization Name:MVHE INC
Other - Org Name:WOODCROFT FAMILY PRACTICE
Other - Org Type:Doing Business As
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:937-499-8205
Mailing Address - Street 1:4235 INDIAN RIPPLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3284
Mailing Address - Country:US
Mailing Address - Phone:937-427-9671
Mailing Address - Fax:937-427-9202
Practice Address - Street 1:4235 INDIAN RIPPLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3284
Practice Address - Country:US
Practice Address - Phone:937-427-9671
Practice Address - Fax:937-427-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9187611Medicare PIN