Provider Demographics
NPI:1710279179
Name:IYP MARKETING CONCEPTS, LLC
Entity Type:Organization
Organization Name:IYP MARKETING CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOWANNA
Authorized Official - Middle Name:LADALE
Authorized Official - Last Name:LUNSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:513-479-8606
Mailing Address - Street 1:6875 CROWN POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-7250
Mailing Address - Country:US
Mailing Address - Phone:513-479-8606
Mailing Address - Fax:513-737-8859
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:#305
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2784
Practice Address - Country:US
Practice Address - Phone:513-867-2811
Practice Address - Fax:513-737-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052457207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0611734Medicaid