Provider Demographics
NPI:1013689132
Name:MCKIBBEN ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MCKIBBEN ENTERPRISES, LLC
Other - Org Name:ANODYNE PAIN & WELLNESS SOLUTIONS OF CENTRAL OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:MCKIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-420-1012
Mailing Address - Street 1:7947 TARTAN FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8778
Mailing Address - Country:US
Mailing Address - Phone:614-420-1012
Mailing Address - Fax:
Practice Address - Street 1:193 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2890
Practice Address - Country:US
Practice Address - Phone:614-420-1012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty