Provider Demographics
NPI:1093227845
Name:OGDEN, ELWOOD
Entity Type:Individual
Prefix:
First Name:ELWOOD
Middle Name:
Last Name:OGDEN
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 1:1101 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-1121
Mailing Address - Country:US
Mailing Address - Phone:937-328-5300
Mailing Address - Fax:937-322-4900
Practice Address - Street 1:255 EAST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45505-1109
Practice Address - Country:US
Practice Address - Phone:937-328-5300
Practice Address - Fax:937-322-4900
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.162642374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician