Provider Demographics
NPI:1932641073
Name:STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT
Entity Type:Organization
Organization Name:STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT
Other - Org Name:TWIN VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-466-0111
Mailing Address - Street 1:30 E BROAD ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-3414
Mailing Address - Country:US
Mailing Address - Phone:614-466-0111
Mailing Address - Fax:614-466-0111
Practice Address - Street 1:2200 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-1668
Practice Address - Country:US
Practice Address - Phone:614-752-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH021201950-033336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167212OtherPK
OH0150152Medicaid
OH0150152Medicaid