Basic Information
| Provider Information | |||||||||
| NPI: | 1649388604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NASH | ||||||||
| FirstName: | ELBERT | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1106 COLEGATE DR | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457501323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405682000 | ||||||||
| FaxNumber: | 7405682096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34008596 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 2136 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 34. 008596 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3810007915 | 05 | WV | MEDICAID | 2698406 | 05 | OH | MEDICAID |