1417377797 NPI number — MEDICAL SERVICE OPTIONS INC

Table of content: (NPI 1417377797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417377797 NPI number — MEDICAL SERVICE OPTIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL SERVICE OPTIONS INC
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:
COMPREHENSIVE ADDICTION CARE CENTERS
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:
1417377797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1325 NORTHUP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLIPOLIS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45631-8830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-645-3301
Provider Business Mailing Address Fax Number:
740-441-9400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1086 JACKSON PIKE STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLIPOLIS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45631-1396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-441-9800
Provider Business Practice Location Address Fax Number:
740-441-9400
Provider Enumeration Date:
04/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANDRY
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
V
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
740-441-9800

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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