Provider Demographics
NPI:1427644111
Name:ANDERSON, MURPHY VS (MEDICAID)
Entity type:Individual
Prefix:MR
First Name:MURPHY
Middle Name:VS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MEDICAID
Other - Prefix:MR
Other - First Name:MURPHY
Other - Middle Name:VS
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MEDICAID
Mailing Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 271
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3568
Mailing Address - Country:US
Mailing Address - Phone:614-622-8737
Mailing Address - Fax:
Practice Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 271
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3568
Practice Address - Country:US
Practice Address - Phone:614-622-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201028801301374U00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3115597Medicaid