Healthcare Provider Details

I. General information

NPI: 1801262118
Provider Name (Legal Business Name): JLH CLINICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 CLEVELAND AVE
COLUMBUS OH
43231-2208
US

IV. Provider business mailing address

5925 CLEVELAND AVE
COLUMBUS OH
43231-2208
US

V. Phone/Fax

Practice location:
  • Phone: 740-601-6071
  • Fax:
Mailing address:
  • Phone: 740-601-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35066575
License Number StateCO

VIII. Authorized Official

Name: JONATHAN HAIMES
Title or Position: OWNER
Credential:
Phone: 740-601-6071