Basic Information
| Provider Information | |||||||||
| NPI: | 1912935545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIMETH | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | KNOX COMMUNITY HOSPITAL | ||||||||
| Address2: | DEPARTMENT OF PRIMARY CARE / FAMILY MEDICINE | ||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430509233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403939000 | ||||||||
| FaxNumber: | 7403922987 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 YAUGER RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430509233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402637036 | ||||||||
| FaxNumber: | 7403993753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471B0102X | N | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Bone Densitometry | 207Q00000X | 35.058819 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0136678 | 05 | OH | MEDICAID |