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NPI Code Detail

MEDICARE: HIGHLIFE ADDICTION MEDICINE AND COUNSELING LLC

MEDICARE: HIGHLIFE ADDICTION MEDICINE AND COUNSELING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RA0401XAddiction Medicine (Internal Medicine) Physician35066575OH

General Provider Information

NPI Number : 1568913283
Entity Type Code : Organization
Provider Name (Legal Business Name) : HIGHLIFE ADDICTION MEDICINE AND COUNSELING LLC
Provider Business Mailing Address
First Line : 5925 CLEVELAND AVE
Second Line : SUITE C
City : COLUMBUS
State : OH
Zip : 43231-2208
Country : US
Telephone Number : 740-601-6071
Fax Number : 800-275-2415
Provider Business Practice Location Address
First Line : 5925 CLEVELAND AVE
Second Line : SUITE C
City : COLUMBUS
State : OH
Zip : 43231-2208
Country : US
Telephone Number : 740-601-6071
Fax Number : 800-275-2415
Authorized Official
Title or Position : MM/CEO
Name : JONATHAN LEE HAIMES
Credential : MD
Telephone Number : 216-543-4843
Provider Enumeration Date : 10/18/2016
Last Update Date : 10/18/2016

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