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NPI Code Detail

MEDICARE: EDEN FAMILY PRACTICE INC.

MEDICARE: EDEN FAMILY PRACTICE 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
1207Q00000XFamily Medicine Physician1939WV

General Provider Information

NPI Number : 1821049776
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDEN FAMILY PRACTICE INC.
Provider Business Mailing Address
First Line : 3306 BRIDGET DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43221-4431
Country : US
Telephone Number : 614-876-9233
Fax Number :
Provider Business Practice Location Address
First Line : 313 HUDGINS ST
Second Line : SUITE 200
City : LOGAN
State : WV
Zip : 25601-3535
Country : US
Telephone Number : 304-752-9450
Fax Number :
Authorized Official
Title or Position : CFO
Name : MRS. PATTY RADCLIFFE
Credential :
Telephone Number : 614-876-9233
Provider Enumeration Date : 05/15/2006
Last Update Date : 08/22/2020

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Directions to “EDEN FAMILY PRACTICE INC. ” Practice Location

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