1265733885 NPI number — HOLISTIC PSYCHIATRY AND ANTI-AGING MEDICINE LLC

Table of content: (NPI 1265733885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265733885 NPI number — HOLISTIC PSYCHIATRY AND ANTI-AGING MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLISTIC PSYCHIATRY AND ANTI-AGING MEDICINE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1265733885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2939 KENNY RD
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43221-2406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-403-2672
Provider Business Mailing Address Fax Number:
614-457-0834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2939 KENNY RD
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43221-2406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-403-2672
Provider Business Practice Location Address Fax Number:
614-457-0834
Provider Enumeration Date:
11/12/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RINGS
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
614-596-8599

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35.044652 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1710077664 . This is a "EIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".