1275961989 NPI number — THE OHIO STATE UNIVERSITY

Table of content: DR. LESLIE KEITH SHOKES MD (NPI 1548333669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275961989 NPI number — THE OHIO STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE OHIO STATE UNIVERSITY
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:
MEDICATION MANAGEMENT PROGRAM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275961989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W 12TH AVE
Provider Second Line Business Mailing Address:
138B PARKS HALL
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43210-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-292-1126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W 12TH AVE
Provider Second Line Business Practice Location Address:
138B PARKS HALL
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-292-1126
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SWEANEY
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICATION MANAGEMENT SPECIALIST
Authorized Official Telephone Number:
614-292-1126

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  022348900 , 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)





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