Provider Demographics
NPI:1568676138
Name:OHIO UNIVERSITY
Entity Type:Organization
Organization Name:OHIO UNIVERSITY
Other - Org Name:OU COMMUNITY HEALTH PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-COMMUNITY HEALTH PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:TRACE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-593-9364
Mailing Address - Street 1:OHIO UNIVERSITY HERITAGE COLLEGE OF OSTEOPATHIC MEDICIN
Mailing Address - Street 2:GROSVENOR HALL 057
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2979
Mailing Address - Country:US
Mailing Address - Phone:740-593-9364
Mailing Address - Fax:740-593-9536
Practice Address - Street 1:OHIO UNIVERSITY HERITAGE COLLEGE OF OSTEOPATHIC MEDICIN
Practice Address - Street 2:GROSVENOR HALL 057
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2979
Practice Address - Country:US
Practice Address - Phone:740-593-9364
Practice Address - Fax:740-593-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2529704Medicaid
OH2529704Medicaid
OHFV95132Medicare PIN