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General NPI Number Information
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NPI Number | 1619440377
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Entity Type | Organization
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Legal Business Name | SCIOTO FAMILY AND BEHAVIORAL MEDICINE
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Dates
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Enumeration Date | 01/05/2019
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 5611 GALLIA ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-5520
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Country | US
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Telephone | 740-529-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 791 MEADOW LN
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City | WHEELERSBURG
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State | OH
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Zip | 45694-8870
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Country | US
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Telephone | 270-871-7379
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JOHN HAASTRUP
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Credential | MD
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Telephone | 270-871-7379
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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