Healthcare Provider Details

I. General information

NPI: 1427644111
Provider Name (Legal Business Name): MURPHY V.S. ANDERSON MEDICAID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MURPHY V.S. ANDERSON MEDICAID

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E DUBLIN GRANVILLE RD STE 271
COLUMBUS OH
43229-3568
US

IV. Provider business mailing address

2021 E DUBLIN GRANVILLE RD STE 271
COLUMBUS OH
43229-3568
US

V. Phone/Fax

Practice location:
  • Phone: 614-622-8737
  • Fax:
Mailing address:
  • Phone: 614-622-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number201028801301
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: