1952336125 NPI number — AMERICAN HEALTH NETWORK OF OHIO, LLC

Table of content: (NPI 1952336125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952336125 NPI number — AMERICAN HEALTH NETWORK OF OHIO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HEALTH NETWORK OF OHIO, LLC
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:
AMERICAN HEALTH NETWORK OF OHIO PROFESSIONAL CORPORATION
Provider Other Organization Name Type Code:
5
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:
1952336125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/28/2020
NPI Reactivation Date:
05/06/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3180 E. BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43209-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-231-2729
Provider Business Mailing Address Fax Number:
614-231-6088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3180 E BROAD ST
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:
43209-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-231-2729
Provider Business Practice Location Address Fax Number:
614-231-6088
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COURTER
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VP OPERATIONS OHIO
Authorized Official Telephone Number:
614-794-5053

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 227900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0153097 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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