Provider Demographics
NPI:1821275611
Name:RENEE SARTAIN D O LLC
Entity Type:Organization
Organization Name:RENEE SARTAIN D O LLC
Other - Org Name:MADELYN RENEE SARTAIN DO
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-766-2220
Mailing Address - Street 1:6905 PERIMETER LOOP RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9601
Mailing Address - Country:US
Mailing Address - Phone:614-766-2220
Mailing Address - Fax:614-799-3023
Practice Address - Street 1:6905 PERIMETER LOOP RD
Practice Address - Street 2:STE 200
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9601
Practice Address - Country:US
Practice Address - Phone:614-766-2220
Practice Address - Fax:614-799-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003964207Q00000X, 207QA0000X, 207QA0505X, 207QG0300X
34003964208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0592729Medicaid
OH0592729Medicaid