OXYCLEAN AMBULATORY OPIATE DETOX CENTERS LLC NPI 1033624812

NPI Information

NPI: 1033624812
Provider Name: OXYCLEAN AMBULATORY OPIATE DETOX CENTERS LLC

Doing Business As: NOT LTD

Classification: Family Medicine - 207QA0401X
Entity Type: Organization

Specialization: Addiction Medicine

Address:
415 S MAIN ST
WAYNESVILLE, OH
ZIP 45068
Phone: (513) 897-7162
Get Directions

OXYCLEAN AMBULATORY OPIATE DETOX CENTERS LLC is an addiction medicine family medicine in Waynesville, OH. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. OXYCLEAN AMBULATORY OPIATE DETOX CENTERS LLC NPI is 1033624812. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Not Ltd.

The provider's business location address is:

415 S MAIN ST
WAYNESVILLE, OH
ZIP 45068-553
Phone: (513) 897-7162

The provider's authorized official is Charles Edward Russell .
The authorized official title is President and has the following contact phone number (937) 718-7677.

The enumeration date for this NPI number is 12/3/2017 and was last updated on 3/17/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QA0401X	Family Medicine	Addiction Medicine	35050063	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1245220912	OTHER		INDIVIDUAL NPI
2	35-0-50063	OTHER	OHIO	STATE MEDICAL BOARD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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