| Dirty South Therapeutics Llc | |
|
77 E Water St Ste 217 Chillicothe OH 45601-2586 | |
| (740) 993-9571 | |
| Not Available |
| Full Name | Dirty South Therapeutics Llc |
|---|---|
| Speciality | Social Worker |
| Location | 77 E Water St Ste 217, Chillicothe, Ohio |
| Authorized Official Name and Position | Daniel Ray Mathuews (OWNER) |
| Authorized Official Contact | 7407012890 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dirty South Therapeutics Llc 77 E Water St Ste 217 Chillicothe OH 45601-2586 Ph: (740) 701-2890 | Dirty South Therapeutics Llc 77 E Water St Ste 217 Chillicothe OH 45601-2586 Ph: (740) 993-9571 |
| NPI Number | 1740052414 |
|---|---|
| Provider Enumeration Date | 10/26/2023 |
| Last Update Date | 01/29/2024 |
| Certification Date | 01/29/2024 |
| Medicare PECOS PAC ID | 4688020126 |
|---|---|
| Medicare Enrollment ID | O20240214000556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740052414 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Daniel Ray Mathuews |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437650413 PECOS PAC ID: 3971909755 Enrollment ID: I20210901003890 |
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