=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306104914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHANIEL T FLATH AA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2012
-----------------------------------------------------
Last Update Date | 05/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 W 10TH AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-293-8487
-----------------------------------------------------
Fax | 614-293-8153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 ACKERMAN RD STE 570
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43202-1579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-293-8487
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367H00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiologist Assistant
-----------------------------------------------------
License Number | 67.000214
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------