Provider Demographics
NPI:1063005643
Name:BYRD, JOSH A
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:A
Last Name:BYRD
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 1:1075 HILLRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1805
Mailing Address - Country:US
Mailing Address - Phone:614-962-1279
Mailing Address - Fax:
Practice Address - Street 1:1075 HILLRIDGE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1805
Practice Address - Country:US
Practice Address - Phone:614-962-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0423906Medicaid