1902077258 NPI number — VIAQUEST HEALTHCARE CENTRAL

Table of content: (NPI 1902077258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902077258 NPI number — VIAQUEST HEALTHCARE CENTRAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIAQUEST HEALTHCARE CENTRAL
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:
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:
1902077258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 METRO PL N
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-5342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-889-5837
Provider Business Mailing Address Fax Number:
614-889-5847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5314 REDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43229-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-436-4769
Provider Business Practice Location Address Fax Number:
614-436-6307
Provider Enumeration Date:
03/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EPPARD
Authorized Official First Name:
SARA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP OF OPERATIONS
Authorized Official Telephone Number:
614-339-0826

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  2514106 , 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: 2514106 . This is a "ODMR/DD LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2600411 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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