1346497989 NPI number — GRANT SCOPE CENTER, LLC

Table of content: (NPI 1346497989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346497989 NPI number — GRANT SCOPE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRANT SCOPE CENTER, 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:
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:
1346497989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 E BROAD ST
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43215-3946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-917-1670
Provider Business Mailing Address Fax Number:
614-947-3991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 E BROAD ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-3946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-917-1670
Provider Business Practice Location Address Fax Number:
614-947-3991
Provider Enumeration Date:
08/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
Authorized Official Title or Position:
BOARD PRESIDENT
Authorized Official Telephone Number:
614-458-1183

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0928AS , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QE0800X , with the licence number: 0928AS , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3004233 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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