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General NPI Number Information
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NPI Number | 1538940929
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Entity Type | Organization
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Legal Business Name | NPMIKE01
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 1500 S HAMILTON RD STE E
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City | COLUMBUS
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State | OH
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Zip | 43227-2414
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Country | US
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Telephone | 855-676-4531
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Fax | 855-676-4531
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Provider Business Mailing Address
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Address Line | PO BOX 27611
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City | COLUMBUS
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State | OH
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Zip | 43227-0611
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Country | US
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Telephone | 855-676-4531
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Fax | 855-676-4531
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL A HODGE
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Credential | APN
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Telephone | 347-451-2739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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