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NPI Code Detail

MEDICARE: FIRST CARE INTEGRATED HEALTH LLC

MEDICARE: FIRST CARE INTEGRATED HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) Physician
2363LF0000XFamily Nurse Practitioner
3363LP2300XPrimary Care Nurse Practitioner
4363LP0808XPsychiatric/Mental Health Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447884077
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIRST CARE INTEGRATED HEALTH LLC
Provider Business Mailing Address
First Line : 6167 BUCKEYE PKWY
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-8387
Country : US
Telephone Number : 614-493-9884
Fax Number :
Provider Business Practice Location Address
First Line : 5150 E MAIN ST STE 102
Second Line :
City : COLUMBUS
State : OH
Zip : 43213-2441
Country : US
Telephone Number : 614-226-5622
Fax Number :
Authorized Official
Title or Position : NP/CEO
Name : FANTA BERETAY
Credential : CNP
Telephone Number : 614-226-5622
Provider Enumeration Date : 02/21/2020
Last Update Date : 06/30/2023

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Directions to “FIRST CARE INTEGRATED HEALTH LLC ” Practice Location

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