1376811216 NPI number — METRO PSYCHIATRY INC

Table of content: (NPI 1376811216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376811216 NPI number — METRO PSYCHIATRY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO PSYCHIATRY INC
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:
1376811216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 182255
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:
43218-2255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-430-5707
Provider Business Mailing Address Fax Number:
614-430-5744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7625 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43016-9649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-717-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
MARK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRES/OWNER
Authorized Official Telephone Number:
614-625-5851

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35081181 , 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)