1407961576 NPI number — JASON WILLIAM NASH D.O.

Table of content: (NPI 1245688217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407961576 NPI number — JASON WILLIAM NASH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NASH
Provider First Name:
JASON
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
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:
1407961576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
428 COUNTRY LINE RD, WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-7294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-847-4100
Provider Business Mailing Address Fax Number:
614-430-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 W. SCHROCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43081-2874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-895-0400
Provider Business Practice Location Address Fax Number:
614-895-2911
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0105X , with the licence number:  41463 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0105X , with the licence number: 34007728 , 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: 2752534 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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