Healthcare Provider Details

I. General information

NPI: 1801854724
Provider Name (Legal Business Name): OHIO STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 TAYLOR AVE
COLUMBUS OH
43203-1779
US

IV. Provider business mailing address

700 ACKERMAN RD SUITE 570
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-3760
  • Fax: 614-257-3148
Mailing address:
  • Phone: 614-293-2391
  • Fax: 614-293-4359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNE SMITH
Title or Position: DIRECTOR CORPORATE CREDENTIALING
Credential:
Phone: 614-293-7444