| Columbus Suboxone Doctors Llc | |
|
3225 Sullivant Ave Columbus OH 43204-1837 | |
| (614) 655-8956 | |
| (614) 748-0569 |
| Full Name | Columbus Suboxone Doctors Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3225 Sullivant Ave, Columbus, Ohio |
| Authorized Official Name and Position | Douglas Lauria (ADMINISTRATOR) |
| Authorized Official Contact | 6146558956 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Columbus Suboxone Doctors Llc 3225 Sullivant Ave Columbus OH 43204-1837 Ph: (614) 655-8956 | Columbus Suboxone Doctors Llc 3225 Sullivant Ave Columbus OH 43204-1837 Ph: (614) 655-8956 |
| NPI Number | 1760940696 |
|---|---|
| Provider Enumeration Date | 03/11/2019 |
| Last Update Date | 01/13/2021 |
| Certification Date | 01/13/2021 |
| Medicare PECOS PAC ID | 8921341256 |
|---|---|
| Medicare Enrollment ID | O20190529002893 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760940696 | NPI | - | NPPES |
| Provider Name | Mark Stanley |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1528038494 PECOS PAC ID: 3577525310 Enrollment ID: I20041103000287 |
| Provider Name | Letisha E Leach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063656239 PECOS PAC ID: 0648316067 Enrollment ID: I20091014000820 |
| Provider Name | Kimberly Glenn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992176606 PECOS PAC ID: 9830487461 Enrollment ID: I20161013001144 |
| Provider Name | Tia Denise Carrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982135943 PECOS PAC ID: 7618235300 Enrollment ID: I20180102000998 |
| Provider Name | Ronna L Holston-kiluvia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235837899 PECOS PAC ID: 2264896398 Enrollment ID: I20230907004261 |
| Provider Name | Jason Paul Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053054205 PECOS PAC ID: 2860846235 Enrollment ID: I20231004000647 |
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