# CLEANSLATE MEDICAL GROUP OF OHIO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558800193
- **Authorized official:** PAUL ROGERS ANDERSON (VICE PRESIDENT)
- **Authorized official phone:** (615) 425-0220

## Contact information

- **Practice address:** 4700 SPRINGBORO PIKE STE C, MORAINE, OH 45439-1982
- **Practice address phone:** (937) 558-5100
- **Practice address fax:** (833) 279-7074
- **Mailing address:** 155 FRANKLIN RD STE 430, BRENTWOOD, TN 37027-1602
- **Mailing address phone:** (615) 425-0220
- **Mailing address fax:** (833) 279-7074

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/15/2017
- **Last updated:** 08/26/2026