Provider Demographics
NPI:1205138872
Name:MVHE INC
Entity type:Organization
Organization Name:MVHE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8213
Mailing Address - Street 1:1911 N FAIRFIELD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2762
Mailing Address - Country:US
Mailing Address - Phone:937-429-1369
Mailing Address - Fax:937-429-4575
Practice Address - Street 1:1911 N FAIRFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2762
Practice Address - Country:US
Practice Address - Phone:937-429-1369
Practice Address - Fax:937-429-4575
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MVHE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-02
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3139179Medicaid
OH3139179Medicaid