Provider Demographics
NPI:1538940929
Name:NPMIKE01
Entity type:Organization
Organization Name:NPMIKE01
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:347-451-2739
Mailing Address - Street 1:PO BOX 27611
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-0611
Mailing Address - Country:US
Mailing Address - Phone:855-676-4531
Mailing Address - Fax:855-676-4531
Practice Address - Street 1:1500 S HAMILTON RD STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2414
Practice Address - Country:US
Practice Address - Phone:855-676-4531
Practice Address - Fax:855-676-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty