NPIMap

Organization Active NPI

Moundbuilders Guidance Center

  • Psychiatry Physician
  • Newark, OH
National Provider Identifier
1366684342
Registry record updated Apr 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MOUNDBUILDERS GUIDANCE CENTER
Practice address
1445 W Main St
Newark, OH 43055-1989
Phone
(740) 522-8477
Fax
(740) 522-2941
NPI assigned
Apr 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2009

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

Authorized official

Name
Mrs. Laura L Edelblute
Title
Chief Operating Officer
Phone
(740) 522-8477

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

1445 W Main St
Newark, OH 43055-1989

Mailing address

65 Messimer Dr
Newark, OH 43055-1874
Phone (740) 522-8477

Other identifiers 1

IdentifierTypeStateIssuer
0200008MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Yoon Hoon Kim MD6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238976000000",
    "number": "1366684342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 MESSIMER DR",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551874",
            "telephone_number": "740-522-8477",
            "fax_number": "740-522-2941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551989",
            "telephone_number": "740-522-8477",
            "fax_number": "740-522-2941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNDBUILDERS GUIDANCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2009-04-06",
        "status": "A",
        "authorized_official_last_name": "EDELBLUTE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "740-522-8477",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0200008",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; 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.