MEDICARE: THE OHIO STATE UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	RES.3252	OH

General Provider Information

NPI Number	:	1235539636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OHIO STATE UNIVERSITY

Provider Business Mailing Address
First Line	:	305 W 12TH AVE
Second Line	:	4088
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-292-5972
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W 12TH AVE
Second Line	:	4088
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-292-5972
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIC RESIDENT
Name	:	KATHY L ELIAS
Credential	:	DMD, PHD
Telephone Number	:	614-361-8966

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	09/04/2014

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Directions to “THE OHIO STATE UNIVERSITY ” Practice Location

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