1194799114 NPI number — STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING

Table of content: (NPI 1194799114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194799114 NPI number — STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING
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:
1194799114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E BROAD ST
Provider Second Line Business Mailing Address:
11TH FL, ATTN:TONYA FASONE
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43215-3414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-466-9930
Provider Business Mailing Address Fax Number:
614-644-9116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1756 SAGAMORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44067-1086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-467-7131
Provider Business Practice Location Address Fax Number:
330-467-2420
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLETTI
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
330-467-7131

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  NA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0150330 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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