| Moon Family & Behavioral Health Llc | |
|
161 Clint Dr Ste 200 Pickerington OH 43147-7794 | |
| (614) 705-6161 | |
| (614) 705-6151 |
| Full Name | Moon Family & Behavioral Health Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 161 Clint Dr Ste 200, Pickerington, Ohio |
| Authorized Official Name and Position | Brian Dean (ADMIN) |
| Authorized Official Contact | 6147065206 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moon Family & Behavioral Health Llc 161 Clint Dr Ste 200 Pickerington OH 43147-7794 Ph: (614) 705-6161 | Moon Family & Behavioral Health Llc 161 Clint Dr Ste 200 Pickerington OH 43147-7794 Ph: (614) 705-6161 |
| NPI Number | 1902512122 |
|---|---|
| Provider Enumeration Date | 01/31/2023 |
| Last Update Date | 01/31/2023 |
| Medicare PECOS PAC ID | 2062887284 |
|---|---|
| Medicare Enrollment ID | O20230331000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902512122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QA0401X | Family Medicine - Addiction Medicine | (* (Not Available)) | Secondary |
| Provider Name | Mamadou Saliou Diallo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922594746 PECOS PAC ID: 6507116332 Enrollment ID: I20180829000895 |
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