Individual
RAYMOND W MICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
1092 JEFFERSON ST, GREENFIELD, OH 45123-8319
(937) 981-1121
(937) 981-5660
Mailing address
PO BOX 637736, CINCINNATI, OH 45263-7736
(513) 891-1006
(513) 793-1032
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN180620
OH
363L00000X
Nurse Practitioner
Primary
NP07584
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344735
ANTHEM
OH
01
—
2355053
RHC MEDICAID FACILITY #
OH
01
—
2355062
RHC MEDICAID 2ND FAC #
OH
05
—
2499005
—
OH
01
—
311674981002
TRI-CARE 2ND FACILITY #
OH
01
—
311674981005
TRI-CARE
OH
01
—
363843
RHC MEDICARE 2ND FAC NUM
OH
01
—
363844
RHC MEDICARE FAC #
OH
Enumeration date
08/16/2005
Last updated
10/02/2012
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