1255712253 NPI number — IDEAL CARE PROVIDERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255712253 NPI number — IDEAL CARE PROVIDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IDEAL CARE PROVIDERS
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:
1255712253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4889 SAWMILL RD
Provider Second Line Business Mailing Address:
SUITE120
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43235-7266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-310-4463
Provider Business Mailing Address Fax Number:
614-300-8152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4889 SAWMILL RD
Provider Second Line Business Practice Location Address:
SUITE120
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43235-7266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-310-4463
Provider Business Practice Location Address Fax Number:
614-300-8152
Provider Enumeration Date:
06/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BARTHOLOMEW GRAHAM
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
DIANDRA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-310-4463

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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