Provider Demographics
NPI:1174878979
Name:BIEDENBACH, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BIEDENBACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:304 MAIN ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1322
Practice Address - Country:US
Practice Address - Phone:740-732-2339
Practice Address - Fax:740-732-2350
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069103Medicaid
WV3810027180Medicaid
WV3810027180Medicaid
OHH122901Medicare PIN
WV3810027180Medicaid