Provider Demographics
NPI:1730336025
Name:CENTRAL OHIO MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:CENTRAL OHIO MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MIS
Authorized Official - Prefix:MS
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-368-7821
Mailing Address - Street 1:250 S HENRY ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-2978
Mailing Address - Country:US
Mailing Address - Phone:740-369-4482
Mailing Address - Fax:740-369-4908
Practice Address - Street 1:250 S HENRY ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2978
Practice Address - Country:US
Practice Address - Phone:740-369-4482
Practice Address - Fax:740-369-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0200875Medicaid
OH9168044Medicare PIN
10199Medicare UPIN
OH0200875Medicaid
OH9168043Medicare PIN