Provider Demographics
NPI:1447222500
Name:TASC OF SOUTHEAST OHIO
Entity Type:Organization
Organization Name:TASC OF SOUTHEAST OHIO
Other - Org Name:SERVING GALLIA, JACKSON AND MEIGS COUNTIES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-339-3032
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:499 JACKSON PIKE, SUITE F
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-0088
Mailing Address - Country:US
Mailing Address - Phone:740-441-2924
Mailing Address - Fax:740-441-2970
Practice Address - Street 1:499 JACKSON PIKE
Practice Address - Street 2:SUITE F
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-0088
Practice Address - Country:US
Practice Address - Phone:740-441-2924
Practice Address - Fax:740-441-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11188Medicare UPIN