1568007425 NPI number — CENTRAL OHIO VASCULAR CARE, INC.

Table of content: DR. THOMAS ANTHONY LEBEAU D.P.M. (NPI 1659587897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568007425 NPI number — CENTRAL OHIO VASCULAR CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO VASCULAR CARE, 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:
Provider Other Organization Name Type Code:
6
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:
1568007425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6488 E MAIN ST STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REYNOLDSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43068-7310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-729-8483
Provider Business Mailing Address Fax Number:
614-472-8483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VIVE VASCULAR 680 BUCKLES CT. N SUITE 2C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAHANNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-472-8483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MANNAVA
Authorized Official First Name:
SRIKRISHNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-729-8483

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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