Healthcare Provider Details

I. General information

NPI: 1598278632
Provider Name (Legal Business Name): THOMAS ANTHONY BODDIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2017
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 S HIGH ST
COLUMBUS OH
43215-5602
US

IV. Provider business mailing address

5900 SHARON WOODS BLVD STE A
COLUMBUS OH
43229-2600
US

V. Phone/Fax

Practice location:
  • Phone: 614-227-9444
  • Fax:
Mailing address:
  • Phone: 614-895-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: