Provider Demographics
NPI:1912310400
Name:MVHE INC
Entity Type:Organization
Organization Name:MVHE INC
Other - Org Name:MEDICAL SOUTH FAMILY PRACTICE
Other - Org Type:Doing Business As
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:937-499-8205
Mailing Address - Street 1:330 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4465
Mailing Address - Country:US
Mailing Address - Phone:937-433-0960
Mailing Address - Fax:937-433-0958
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4465
Practice Address - Country:US
Practice Address - Phone:937-433-0960
Practice Address - Fax:937-433-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9187611Medicare PIN