Provider Demographics
NPI:1346780285
Name:BEYENE, DEBEBE
Entity Type:Individual
Prefix:
First Name:DEBEBE
Middle Name:
Last Name:BEYENE
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 1:261 W JOHNSTOWN RD
Mailing Address - Street 2:SUITE # 212
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2796
Mailing Address - Country:US
Mailing Address - Phone:614-866-6666
Mailing Address - Fax:
Practice Address - Street 1:261 W JOHNSTOWN RD
Practice Address - Street 2:SUITE # 212
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2796
Practice Address - Country:US
Practice Address - Phone:614-866-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-25
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300326983343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099928Medicaid