1699179929 NPI number — OSUP COMMUNITY OUTREACH LLC

Table of content: (NPI 1699179929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699179929 NPI number — OSUP COMMUNITY OUTREACH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSUP COMMUNITY OUTREACH 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:
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:
1699179929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 ACKERMAN RD STE 2120
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:
43202-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-685-4601
Provider Business Mailing Address Fax Number:
614-366-3731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 METRO PL N
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:
43017-5362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-410-9580
Provider Business Practice Location Address Fax Number:
614-844-4589
Provider Enumeration Date:
10/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SHARP
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
614-293-3202

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DV2507 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0112258 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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