Provider Demographics
NPI:1821561135
Name:POPE, TOMIKA A (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:TOMIKA
Middle Name:A
Last Name:POPE
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SAINT LEGER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2936
Mailing Address - Country:US
Mailing Address - Phone:330-606-0830
Mailing Address - Fax:
Practice Address - Street 1:395 SAINT LEGER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2936
Practice Address - Country:US
Practice Address - Phone:330-606-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0056805251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056805Medicaid