=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780868836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORPORATE HEALTH SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 12/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 WESTERVIEW DR
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-2682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-942-0142
-----------------------------------------------------
Fax | 740-657-1617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8917 SOUTH OLD STATE RD STE 124
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-942-0142
-----------------------------------------------------
Fax | 740-657-1617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRES
-----------------------------------------------------
Name | DR. RYAN D HERRINGTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 614-942-0142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 35077264
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------