Oxyclean Ambulatory Opiate Detox Centers LLC

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

35050063 Issued in OH

Legal business name

OXYCLEAN AMBULATORY OPIATE DETOX CENTERS LLC

Practice address

415 S Main St
Waynesville, OH 45068-9553

Phone

(513) 897-7162

NPI assigned

Dec 3, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles Edward Russell, MDNPI 1245220912

Title

President

Phone

(937) 718-7677

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• NOT ltd Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles E Russell, MD

  • Addiction Medicine (Preventive Medicine) Physician
  • Dayton, OH
  • NPI 1245220912
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1033624812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3195 DAYTON XENIA RD # 900-162",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454346390",
            "telephone_number": "937-718-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S MAIN ST",
            "city": "WAYNESVILLE",
            "state": "OH",
            "postal_code": "450689553",
            "telephone_number": "513-897-7162"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11134 Luschek Dr",
            "address_purpose": "LOCATION",
            "city": "Blue Ash",
            "state": "OH",
            "postal_code": "452412434",
            "country_code": "US",
            "telephone_number": "513-827-9273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Elizabeth Pl",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454173445",
            "country_code": "US",
            "telephone_number": "937-203-2469",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2611 Wayne Ave",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454201833",
            "country_code": "US",
            "telephone_number": "937-256-7801",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "313 Chillicothe Ave",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OH",
            "postal_code": "451337378",
            "country_code": "US",
            "telephone_number": "937-393-9720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OXYCLEAN AMBULATORY OPIATE DETOX CENTERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-03",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-718-7677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "OH",
            "license": "35050063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL BOARD",
            "identifier": "35-0-50063",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1245220912",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NOT ltd",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Addiction Medicine (Family Medicine) Physician in Waynesville, OH
• Providers in Waynesville, OH by specialty
• Addiction Medicine (Family Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.