Cleanse Clinic Jeffersonville LLC

Primary specialty

Addiction Psychiatry PhysicianTaxonomy code 2084P0802X

License

1784-0-ASO Issued in IN

Legal business name

CLEANSE CLINIC JEFFERSONVILLE LLC

Practice address

1700 State St
New Albany, IN 47150-4916

Phone

(812) 914-7038

Fax

(812) 748-6035

NPI assigned

Sep 5, 2017

Last updated

Jan 31, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

CLEANSE CLINIC CORPORATIONAs reported in NPPES

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

Authorized official

Name

Abdul G Buridi, MD

Title

Ceo

Phone

(502) 773-5088

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kathi Oneal, PA-C

  • Physician Assistant
  • New Albany, IN
  • NPI 1538635263
  NPD (past)

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1942728472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 W BROADWAY STE 202",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023245",
            "telephone_number": "502-561-0943",
            "fax_number": "502-561-0944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 STATE ST",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471504916",
            "telephone_number": "812-914-7038",
            "fax_number": "812-748-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEANSE CLINIC JEFFERSONVILLE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CLEANSE CLINIC CORPORATION",
        "enumeration_date": "2017-09-05",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "BURIDI",
        "authorized_official_first_name": "ABDUL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-773-5088",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "IN",
            "license": "1784-0-ASO",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300008912",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Alexander Clark, CAA
• William Clark
• Brandy Lynn Clary, MSN, APRN, FNP-C
• Christian Denis Clasby, M.D.
• John D Clayton, D.O.
• Travis Edward Clegg, M.D.
• Tawana Coates, MD, MPH
• Cobbler Station Family Clinic
• Cobbler Station Internists
• Susan Kay Cochran, LCSW, CSW-G, ACSW

• Addiction Psychiatry Physician in New Albany, IN
• Providers in New Albany, IN by specialty
• Addiction Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.