Healthcare Provider Details

I. General information

NPI: 1588827299
Provider Name (Legal Business Name): OHIO UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HEALTH CENTER DR
ATHENS OH
45701-2907
US

IV. Provider business mailing address

PO BOX 5199
ABILENE TX
79608-5199
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-1911
  • Fax:
Mailing address:
  • Phone: 866-890-6390
  • Fax: 325-437-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACKIE LEGG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 740-593-1911