MEDICARE: STATE OF OHIO BUDGET AND MANAGEMENT STATE ACCOUNTING

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
1	333600000X	Pharmacy
2	3336M0002X	Mail Order Pharmacy	020412900	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2081095	OTHER		PK

General Provider Information

NPI Number	:	1952587396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF OHIO BUDGET AND MANAGEMENT STATE ACCOUNTING

Provider Business Mailing Address
First Line	:	2150 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1257
Country	:	US
Telephone Number	:	614-752-0140
Fax Number	:	614-752-0056

Provider Business Practice Location Address
First Line	:	2150 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1257
Country	:	US
Telephone Number	:	614-752-0140
Fax Number	:	614-752-0056

Authorized Official
Title or Position	:	OHIOMHAS OPS CHIEF
Name	:	TIMOTHY BODLE
Credential	:	RPH
Telephone Number	:	614-752-0116

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	02/26/2024

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Directions to “STATE OF OHIO BUDGET AND MANAGEMENT STATE ACCOUNTING ” Practice Location

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