Provider Demographics
NPI:1457304305
Name:MVHE, INC.
Entity Type:Organization
Organization Name:MVHE, INC.
Other - Org Name:TROY PIKE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
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 1:8638 OLD TROY PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1051
Mailing Address - Country:US
Mailing Address - Phone:937-233-5574
Mailing Address - Fax:937-233-7313
Practice Address - Street 1:8638 OLD TROY PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1051
Practice Address - Country:US
Practice Address - Phone:937-233-5574
Practice Address - Fax:937-233-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741933Medicaid
TR9925311Medicare ID - Type UnspecifiedGPR PROV #