Organization
OSUP COMMUNITY OUTREACH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE L. SHARP (ASSOCIATE EXECUTIVE DIRECTOR)
(614) 293-3202
Entity
Organization
Contact information
Practice address
555 METRO PL N, DUBLIN, OH 43017-5362
(614) 410-9580
(614) 844-4589
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 685-4601
(614) 366-3731
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112258
—
OH
01
—
DV2507
RAILROAD MEDICARE
OH
Enumeration date
10/15/2014
Last updated
01/26/2023
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