Healthcare Provider Details

I. General information

NPI: 1699692491
Provider Name (Legal Business Name): MATTHEW ROBERT NEAVILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 SUMMIT ST
COLUMBUS OH
43201-1391
US

IV. Provider business mailing address

2205 SUMMIT ST
COLUMBUS OH
43201-1391
US

V. Phone/Fax

Practice location:
  • Phone: 614-980-2125
  • Fax:
Mailing address:
  • Phone: 614-980-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: