Healthcare Provider Details

I. General information

NPI: 1437169760
Provider Name (Legal Business Name): PICKAWAY HEALTH SERGVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 CIRCLEVILLE PLAZA DR
CIRCLEVILLE OH
43113-2269
US

IV. Provider business mailing address

617 LANCASTER PIKE SUITE C
CIRCLEVILLE OH
43113-8826
US

V. Phone/Fax

Practice location:
  • Phone: 740-420-7975
  • Fax: 740-420-8637
Mailing address:
  • Phone: 740-420-8078
  • Fax: 740-477-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: WENDY C ELLIOTT
Title or Position: EXEDCUTIVE DIRECTOR
Credential:
Phone: 740-420-8078