MEDICARE: MEDICAL AND NATURAL NUTRITIONAL ALTERNATIVES INC

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	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1942484167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL AND NATURAL NUTRITIONAL ALTERNATIVES INC

Provider Business Mailing Address
First Line	:	730 MOUNT AIRYSHIRE BLVD # A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1328
Country	:	US
Telephone Number	:	614-848-2600
Fax Number	:	614-848-3349

Provider Business Practice Location Address
First Line	:	730 MOUNT AIRYSHIRE BLVD A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1328
Country	:	US
Telephone Number	:	614-848-2600
Fax Number	:	614-848-3349

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY STEWART EVERHART
Credential	:	M.D.
Telephone Number	:	614-848-2600

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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