Provider Demographics
NPI:1609321694
Name:HAYCOX, MARK
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:HAYCOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 N CHURCH DR
Mailing Address - Street 2:#203
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4784
Mailing Address - Country:US
Mailing Address - Phone:440-843-7279
Mailing Address - Fax:
Practice Address - Street 1:9333 N CHURCH DR
Practice Address - Street 2:#203
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4784
Practice Address - Country:US
Practice Address - Phone:440-843-7279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0168660374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168660Medicaid