Provider Demographics
NPI:1013953942
Name:DENNIS J. PIERSON, M.D., INC.
Entity Type:Organization
Organization Name:DENNIS J. PIERSON, M.D., INC.
Other - Org Name:PIERSON FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-227-9676
Mailing Address - Street 1:1220 E ELM ST
Mailing Address - Street 2:STE 240
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2898
Mailing Address - Country:US
Mailing Address - Phone:419-227-9676
Mailing Address - Fax:419-227-9794
Practice Address - Street 1:1220 E ELM ST
Practice Address - Street 2:STE 240
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2898
Practice Address - Country:US
Practice Address - Phone:419-227-9676
Practice Address - Fax:419-227-9794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-043987P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH735029OtherBUCKEYE
OH2174105Medicaid
OH5641551OtherAETNA HMO
OH0636167OtherAETNA
OHCG1874OtherRAILROAD MEDICARE-PALMETT
OH000000031107OtherANTHEM BCBS
OH5641551OtherAETNA HMO
OH2174105Medicaid