Basic Information
| Provider Information | |||||||||
| NPI: | 1801801634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHBAUGH | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | ELDON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 W MARTZ STREET | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375481535 | ||||||||
| FaxNumber: | 9375483138 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 SUMMIT ROAD | ||||||||
| Address2: | SUMMIT BEHAVIORAL HEALTHCARE | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452372621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139483721 | ||||||||
| FaxNumber: | 5139488631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 12/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35049927 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 0103119A | IN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000000019441 | 01 | ANTHEM BCBS | OTHER | MIS243081000 | 01 | MAGELLAN BEHAVIORAL HEALT | OTHER | 0562154 | 05 | OH | MEDICAID | 260020831 | 01 | MEDICARE RR | OTHER | 31140631400 | 01 | WORKMANS COMP | OTHER |