Provider Demographics
NPI:1215115647
Name:MITCHELL DALVIN
Entity type:Organization
Organization Name:MITCHELL DALVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-799-3383
Mailing Address - Street 1:1749 S RACCOON RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4703
Mailing Address - Country:US
Mailing Address - Phone:330-799-3383
Mailing Address - Fax:330-799-3505
Practice Address - Street 1:1749 S RACCOON RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4703
Practice Address - Country:US
Practice Address - Phone:330-799-3383
Practice Address - Fax:330-799-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002104332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169680001Medicare NSC