CLEANSLATE MEDICAL GROUP OF OHIO LLC (NPI# 1558800193) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558800193 |
| Entity Type | Organization |
| Organization Name | CLEANSLATE MEDICAL GROUP OF OHIO LLC |
| Practice Address |
4488 W Broad St Ste 3 Columbus OH 43228-5610 |
| Mailing Address |
15 Century Blvd Ste 307 Nashville TN 37214-3692 |
| Practice Telephone | 1464531589 |
| Mailing Telephone | 6154250220 |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2019-07-02 |
| Authorized Official Name | ROBERT HUTCHISON (CFO) |
| Authorized Official Telephone | 4135842173 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
4488 W BROAD ST STE 3 |
| City | COLUMBUS |
| State | OH |
| Zip Code | 43228-5610 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831720804 | Alexandra Schirmer | Physician Assistant | 4488 W Broad St Ste 3, Columbus, OH 43228-5610 | 2020-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629694229 | The Laurels of West Columbus, LLC | Skilled Nursing Facility | 441 Norton Rd, Columbus, OH 43228 | 2020-06-19 |
| 1538788146 | Colin Rogers | Student in an Organized Health Care Education/Training Program | Ohiohealth Doctors Hospital, 5100 West Broad Street, Columbus, OH 43228 | 2020-04-14 |
| 1093343899 | Cameron Alvin Gachett | Student in an Organized Health Care Education/Training Program | Ohiohealth Doctors Hospital Community Medicine Clinic, 50 Old Village Road, Columbus, OH 43228 | 2020-03-29 |
| 1407483431 | Zachary Werner | Student in an Organized Health Care Education/Training Program | Ohio Health Doctors Hospital, 5100 West Broad Street, Columbus, OH 43228 | 2020-03-27 |
| 1831684232 | Medcare Clinic LLC | Clinic/Center | 4125 W Broad St, Columbus, OH 43228 | 2018-06-27 |
| 1952893950 | Midland Medical Group, LLC | Family Medicine | 1000 Georgesville Rd, Columbus, OH 43228 | 2018-06-05 |
| 1619478336 | Charles Norris Fennie | Student in an Organized Health Care Education/Training Program | Doctors Hospital Community Medicine Clinic, 50 Old Village Road, Columbus, OH 43228 | 2018-02-27 |
| 1902304389 | Icare Health & Wellness Medical Center, LLC | Counselor | 5152 W.broad St, Suite A, Columbus, OH 43228 | 2018-01-31 |
| 1104334523 | Inner Health Chiropractic, Inc | Chiropractor | 5125 West Broad Street, Inner Health Chiropractic, Columbus, OH 43228 | 2018-01-19 |
| 1205363777 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2182 Dividend Drive, Columbus, OH 43228 | 2017-05-16 |
| Find all providers in zip 43228 | ||||
| Taxonomy Code | 207RA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Addiction Medicine |
| An internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649279373 | Anthony Dean Agra | Internal Medicine | 547 E 11th Ave, Columbus, OH 43211-2603 | 2005-07-15 |
| 1568913283 | Highlife Addiction Medicine and Counseling LLC | Internal Medicine | 5925 Cleveland Ave, Suite C, Columbus, OH 43231-2208 | 2016-10-18 |
| 1801262118 | Jlh Clinical Services | Internal Medicine | 5925 Cleveland Ave, Columbus, OH 43231-2208 | 2015-08-20 |
| 1396148375 | Addiction Angels of America, LLC | Internal Medicine | 4889 Sinclair Rd, Suite 111, Columbus, OH 43229-5432 | 2014-10-03 |
| 1811328594 | Poel, Inc. | Internal Medicine | 1120 Polaris Pkwy, Columbus, OH 43240-4042 | 2013-12-06 |
| 1275964348 | Poel, Inc. | Internal Medicine | 1430 S High St, Columbus, OH 43207-1045 | 2013-11-27 |
| 1598704710 | Tom H Pepper | Internal Medicine | 1492 E Broad St, Columbus, OH 43205-1546 | 2006-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861916330 | First Horizon Solutions, LLC | Internal Medicine | 3730 Tabs Dr Ste 102, Uniontown, OH 44685-9562 | 2017-07-27 |
| 1841238094 | Christopher T. Meyer | Internal Medicine | 75 Hospital Dr Ste 350, Athens, OH 45701-2867 | 2006-06-02 |
| 1417933490 | James Frederick Guenther | Internal Medicine | 1319 E Main St, Lancaster, OH 43130-4005 | 2005-12-21 |
| 1528051661 | Cynthia L Brown | Internal Medicine | 2351 E 22nd St, St Vincent Charity Hospital Attn: Gma Consultants, Cleveland, OH 44115-3111 | 2005-08-24 |
| 1639170509 | Patrick Bruno | Internal Medicine | 3535 Lee Rd, Shaker Heights, OH 44120-5122 | 2005-08-02 |
| 1245233345 | Parag J Patel | Internal Medicine | 446 Morgan St, Cincinnati, OH 45206-2348 | 2005-05-23 |
| 1790382752 | Keyona Shine | Internal Medicine | 2101 Silver Maple Way, Lorain, OH 44053-2380 | 2020-10-02 |
| 1902413677 | Stacey Whitesel | Internal Medicine | 2101 Silver Maple Way, Lorain, OH 44053-2380 | 2020-09-28 |
| 1184158743 | Hope Recovery Center LLC | Internal Medicine | 387 County Line Rd W, Westerville, OH 43082-6080 | 2017-04-20 |
| 1558807610 | R Health Matters LLC | Internal Medicine | 18 Grace Dr, Powell, OH 43065-8466 | 2017-01-13 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CLEANSLATE MEDICAL GROUP OF OHIO LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.