Provider Demographics
NPI:1912935545
Name:NIMETH, BRENT CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:CHARLES
Last Name:NIMETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KNOX COMMUNITY HOSPITAL
Mailing Address - Street 2:DEPARTMENT OF PRIMARY CARE / FAMILY MEDICINE
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9233
Mailing Address - Country:US
Mailing Address - Phone:740-393-9000
Mailing Address - Fax:740-392-2987
Practice Address - Street 1:1220 YAUGER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9233
Practice Address - Country:US
Practice Address - Phone:740-263-7036
Practice Address - Fax:740-399-3753
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2471B0102X
OH35.058819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0136678Medicaid
OH1396735OtherUNITED HEALTHCARE OF OHIO
OH000000019298OtherANTHEM BC/BS
OHNI0780722Medicare ID - Type Unspecified
OH0136678Medicaid