MEDICARE: CENTRAL OHIO NUTRITION CENTER, INC

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
1	133V00000X	Registered Dietitian
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1528245685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL OHIO NUTRITION CENTER, INC

Provider Business Mailing Address
First Line	:	450 ALKYRE RUN STE 120
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-6910
Country	:	US
Telephone Number	:	614-847-6008
Fax Number	:	614-847-6021

Provider Business Practice Location Address
First Line	:	9039 ANTARES AVE STE C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43240-4067
Country	:	US
Telephone Number	:	614-847-6008
Fax Number	:	614-847-6021

Authorized Official
Title or Position	:	OWNER DIRECTOR
Name	:	JUDY F LOPER
Credential	:	PHD RD LD
Telephone Number	:	614-864-7225

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	08/22/2023

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