Basic Information
| Provider Information | |||||||||
| NPI: | 1215150560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEAL J. NESBITT, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 HOSPITAL DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405946100 | ||||||||
| FaxNumber: | 7405946903 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 HOSPITAL DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405946100 | ||||||||
| FaxNumber: | 7405946903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NESBITT | ||||||||
| AuthorizedOfficialFirstName: | NEAL | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7405946100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35064804 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2550378 | 05 | OH | MEDICAID |