Healthcare Provider Details

I. General information

NPI: 1225960735
Provider Name (Legal Business Name): ELIJAH LUCAS BYRD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3699 PARAGON DR
COLUMBUS OH
43228-9751
US

IV. Provider business mailing address

6448 RIVERSTONE DR
COLUMBUS OH
43228-9342
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-6651
  • Fax:
Mailing address:
  • Phone: 865-207-4068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number179853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: