MEDICARE: STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT STATE ACCOUNTING

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	333600000X	Pharmacy
2	3336M0002X	Mail Order Pharmacy	020171800	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143244	OTHER		PK

General Provider Information

NPI Number	:	1336263029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT STATE ACCOUNTING

Provider Business Mailing Address
First Line	:	2150 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1257
Country	:	US
Telephone Number	:	614-752-0150
Fax Number	:	614-752-0151

Provider Business Practice Location Address
First Line	:	2150 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1257
Country	:	US
Telephone Number	:	614-752-0150
Fax Number	:	614-752-0151

Authorized Official
Title or Position	:	OHIOMHAS OPS CHIEF
Name	:	BRANDON HAAS
Credential	:
Telephone Number	:	614-752-0116

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/21/2020

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Directions to “STATE OF OHIO OFFICE OF BUDGET & MANAGEMENT STATE ACCOUNTING ” Practice Location

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