Provider Demographics
NPI:1144764473
Name:ICT VENTURE GROUP LL
Entity Type:Organization
Organization Name:ICT VENTURE GROUP LL
Other - Org Name:LICE CLINICS OF AMERICA COLUMBUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-335-5015
Mailing Address - Street 1:345 S BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1305
Mailing Address - Country:US
Mailing Address - Phone:614-335-5015
Mailing Address - Fax:
Practice Address - Street 1:951 WORTHINGTON WOODS LOOP RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-5743
Practice Address - Country:US
Practice Address - Phone:614-335-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service