1831609940 NPI number — CAITLIN FOLSOM

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 1831609940 NPI number — CAITLIN FOLSOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOLSOM
Provider First Name:
CAITLIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1831609940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 781625
Provider Second Line Business Mailing Address:
P.O. BOX 78000
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48278-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-355-8004
Provider Business Mailing Address Fax Number:
614-355-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 BUTTERFLY GARDENS DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-7508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-938-0167
Provider Business Practice Location Address Fax Number:
614-938-0170
Provider Enumeration Date:
10/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  APRN.CNP.021376 , 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)

  • Identifier: 0253312 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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