Provider Demographics
NPI:1184025298
Name:GOGETEMGIRL ENTERTAINMENT
Entity type:Organization
Organization Name:GOGETEMGIRL ENTERTAINMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT MEDICAID PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:STNA
Authorized Official - Phone:614-260-5444
Mailing Address - Street 1:1723 SHADY LANE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2576
Mailing Address - Country:US
Mailing Address - Phone:614-260-5444
Mailing Address - Fax:
Practice Address - Street 1:1723 SHADY LANE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2576
Practice Address - Country:US
Practice Address - Phone:614-260-5444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401224260411305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service