Provider Demographics
NPI:1669047924
Name:OHIO STATE UNIVERSITY - CAP
Entity type:Organization
Organization Name:OHIO STATE UNIVERSITY - CAP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-293-2229
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:888-663-6331
Mailing Address - Fax:380-223-2984
Practice Address - Street 1:3870 TOWNSFAIR WAY # 103-B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6173
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:380-223-2984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO STATE UNIVERSITY-CAP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-20
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2043158Medicaid