Healthcare Provider Details

I. General information

NPI: 1043241854
Provider Name (Legal Business Name): GREGORY BICKLEY C-AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE N411 DOAN
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

410 W 10TH AVE N411 DOAN
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8487
  • Fax: 614-293-8153
Mailing address:
  • Phone: 614-293-8487
  • Fax: 614-293-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number001733
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67000288
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: