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General NPI Number Information
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NPI Number | 1508199332
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Entity Type | Organization
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Legal Business Name | JOHN NASH DO LLC
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 215 OHIO ST
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City | MARIETTA
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State | OH
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Zip | 45750-3137
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Country | US
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Telephone | 740-374-0508
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Fax | 740-374-2094
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Provider Business Mailing Address
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Address Line | PO BOX 2169
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City | MARIETTA
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State | OH
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Zip | 45750-7169
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Country | US
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Telephone | 740-374-0508
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Fax | 740-374-2094
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELBERT JOHN NASH
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Credential | D.O.
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Telephone | 740-374-0508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 34008596
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License Number State | OH
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