Provider Demographics
NPI:1760668370
Name:EMERALD DRYWALL LTD,
Entity Type:Organization
Organization Name:EMERALD DRYWALL LTD,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCIPIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-593-8778
Mailing Address - Street 1:104 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-1408
Mailing Address - Country:US
Mailing Address - Phone:937-593-8778
Mailing Address - Fax:937-593-9778
Practice Address - Street 1:104 DETROIT ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-1408
Practice Address - Country:US
Practice Address - Phone:937-593-8778
Practice Address - Fax:937-593-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH171W00000XMedicare Oscar/Certification