Provider Demographics
NPI:1164107975
Name:SUBTLETY LIMITED
Entity Type:Organization
Organization Name:SUBTLETY LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-586-6573
Mailing Address - Street 1:359 GRACELAND BLVD UNIT 204
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1887
Mailing Address - Country:US
Mailing Address - Phone:614-586-6573
Mailing Address - Fax:855-978-1246
Practice Address - Street 1:1161 BETHEL RD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2773
Practice Address - Country:US
Practice Address - Phone:614-586-6573
Practice Address - Fax:855-978-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275786386OtherINDIVIDUAL NPI
3243457OtherUNITEDHEALTHCARE
9150236OtherAETNA
OHCS1808500125OtherCARESOURCE
643276OtherOPTUM
680129OtherANTHEM
OH0211098Medicaid
OHPDZ000000415698OtherAETNA BETTER HEALTH OF OHIO
5404840OtherCIGNA EVERNORTH