Provider Demographics
NPI:1083192918
Name:12 MERIDIANS ACUPUNCTURE
Entity Type:Organization
Organization Name:12 MERIDIANS ACUPUNCTURE
Other - Org Name:12 MERIDIANS ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIGITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:614-284-8017
Mailing Address - Street 1:2511 OAKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-7612
Mailing Address - Country:US
Mailing Address - Phone:614-423-8368
Mailing Address - Fax:833-790-5341
Practice Address - Street 1:2511 OAKSTONE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7612
Practice Address - Country:US
Practice Address - Phone:614-423-8368
Practice Address - Fax:833-790-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000187261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1003109760Medicaid