Provider Demographics
NPI:1831151927
Name:MIAMI VALLEY CYTOLOGY
Entity type:Organization
Organization Name:MIAMI VALLEY CYTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CYTOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:
Authorized Official - Last Name:YAREMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:937-293-0773
Mailing Address - Street 1:999 BRUBAKER DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3588
Mailing Address - Country:US
Mailing Address - Phone:937-293-0773
Mailing Address - Fax:
Practice Address - Street 1:7415 BRANDT PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3239
Practice Address - Country:US
Practice Address - Phone:937-293-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36DO350260291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0923102Medicaid
OH9224921Medicare PIN