Provider Demographics
NPI:1720066236
Name:PAMELA SPITLER
Entity Type:Organization
Organization Name:PAMELA SPITLER
Other - Org Name:PAMELA'S INTIMATE APPAREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SPITLER
Authorized Official - Suffix:
Authorized Official - Credentials:RFM
Authorized Official - Phone:937-547-1144
Mailing Address - Street 1:534 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1927
Mailing Address - Country:US
Mailing Address - Phone:937-547-1144
Mailing Address - Fax:937-547-1946
Practice Address - Street 1:534 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1927
Practice Address - Country:US
Practice Address - Phone:937-547-1144
Practice Address - Fax:937-547-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRFM00490332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2363544Medicaid
OH1293670001Medicare NSC