Healthcare Provider Details

I. General information

NPI: 1689763740
Provider Name (Legal Business Name): ACCESS OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E BROAD ST STE 400
COLUMBUS OH
43213-2979
US

IV. Provider business mailing address

6400 E BROAD ST STE 400
COLUMBUS OH
43213-2979
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-3345
  • Fax: 614-317-4689
Mailing address:
  • Phone: 614-655-3345
  • Fax: 614-317-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number603
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN A JOHNSON
Title or Position: CEO
Credential: MD
Phone: 614-655-3345