Provider Demographics
NPI:1598037459
Name:MVHE INC
Entity Type:Organization
Organization Name:MVHE INC
Other - Org Name:ZOLLETT MEDICAL ASSOCIATES
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:937-499-8213
Mailing Address - Street 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:STE 490
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5182
Mailing Address - Country:US
Mailing Address - Phone:513-424-1291
Mailing Address - Fax:513-424-9422
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:STE 490
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5182
Practice Address - Country:US
Practice Address - Phone:513-424-1291
Practice Address - Fax:513-424-9422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MVHE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-07
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0060617Medicaid
OH9187611Medicare PIN