Provider Demographics
NPI:1346291085
Name:MEDPSYCH OHIO VALLEY , INC
Entity Type:Organization
Organization Name:MEDPSYCH OHIO VALLEY , INC
Other - Org Name:PSYCHOLOGICAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BALRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-430-9697
Mailing Address - Street 1:8472 COTTER ST
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7139
Mailing Address - Country:US
Mailing Address - Phone:614-430-9697
Mailing Address - Fax:614-430-9837
Practice Address - Street 1:8472 COTTER ST
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7139
Practice Address - Country:US
Practice Address - Phone:614-430-9697
Practice Address - Fax:614-430-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000323495OtherBCBS #
OH2219227Medicaid