Provider Demographics
NPI:1942484167
Name:MEDICAL AND NATURAL NUTRITIONAL ALTERNATIVES INC
Entity type:Organization
Organization Name:MEDICAL AND NATURAL NUTRITIONAL ALTERNATIVES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:EVERHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-848-2600
Mailing Address - Street 1:730 MOUNT AIRYSHIRE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1328
Mailing Address - Country:US
Mailing Address - Phone:614-848-2600
Mailing Address - Fax:614-848-3349
Practice Address - Street 1:730 MOUNT AIRYSHIRE BLVD A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1328
Practice Address - Country:US
Practice Address - Phone:614-848-2600
Practice Address - Fax:614-848-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty