Active NPI
Kimberly S Tadlock
- Home Health Aide
- Manchester, OH
National Provider Identifier
1669607271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- 2852131
- Practice address
- 2980 Suck Run Rd
Manchester, OH 45144-8121 - Phone
- (937) 549-4345
- NPI assigned
- May 27, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 2852131 | OH | Primary |
Addresses
Primary practice location
2980 Suck Run Rd
Manchester, OH 45144-8121
Mailing address
2980 Suck Run Rd
Manchester, OH 45144-8121
Phone (937) 549-4345
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2852131 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2852131 | OH | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243382400000",
"number": "1669607271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2980 SUCK RUN RD",
"city": "MANCHESTER",
"state": "OH",
"postal_code": "451448121",
"telephone_number": "937-549-4345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2980 SUCK RUN RD",
"city": "MANCHESTER",
"state": "OH",
"postal_code": "451448121",
"telephone_number": "937-549-4345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TADLOCK",
"first_name": "KIMBERLY",
"middle_name": "S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-05-27",
"last_updated": "2009-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "OH",
"license": "2852131",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2852131",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manchester, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.