Provider Demographics
NPI:1619440377
Name:SCIOTO FAMILY AND BEHAVIORAL MEDICINE
Entity Type:Organization
Organization Name:SCIOTO FAMILY AND BEHAVIORAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAASTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-871-7379
Mailing Address - Street 1:791 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-8870
Mailing Address - Country:US
Mailing Address - Phone:270-871-7379
Mailing Address - Fax:
Practice Address - Street 1:5611 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5520
Practice Address - Country:US
Practice Address - Phone:740-529-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty