Basic Information
| Provider Information | |||||||||
| NPI: | 1437151024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 265 W UNION ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405942456 | ||||||||
| FaxNumber: | 7405949630 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 W UNION ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405942456 | ||||||||
| FaxNumber: | 7405949630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 07/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 34-0059835 | OH | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 0988632 | 05 | OH | MEDICAID |