Basic Information
| Provider Information | |||||||||
| NPI: | 1740714195 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACCESS OHIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4725 PARKWICK DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432286401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146553354 | ||||||||
| FaxNumber: | 6143174692 | ||||||||
| Practice Location | |||||||||
| Address1: | 4725 PARKWICK DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432286401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146553354 | ||||||||
| FaxNumber: | 6143174692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2017 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6146553354 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 411615 | OH | Y | Agencies | Community/Behavioral Health |
No ID Information.