Oxyclean Ambulatory Opiate Detox Centers LLC
NPI #1033624812 in Waynesville, Ohio
Provider Information
- NPI Number
- 1033624812
- Entity Type
- Organization
- Organization Name
- Oxyclean Ambulatory Opiate Detox Centers LLC
- Primary Specialty
- Family Medicine - Addiction Medicine
- Enumeration Date
- Dec 3, 2017
- Last Updated
- Mar 17, 2018
Practice Location
- Address
- 415 S MAIN ST
- City
- Waynesville
- State
- Ohio
- ZIP Code
- 45068-9553
- Phone
- (513) 897-7162
Authorized Official
- Name
- DR. CHARLES EDWARD RUSSELL, MD
- Title
- PRESIDENT
- Phone
- (937) 718-7677
Specialties & Taxonomy Codes
| Specialty |
|---|
| Family Medicine - Addiction Medicine — Addiction Medicine |
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