Healthcare Provider Details

I. General information

NPI: 1144719584
Provider Name (Legal Business Name): ALLEN LOVELACE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 S HAMILTON RD STE 100
COLUMBUS OH
43232-4317
US

IV. Provider business mailing address

1515 E BROAD ST
COLUMBUS OH
43205-1550
US

V. Phone/Fax

Practice location:
  • Phone: 855-519-2787
  • Fax: 614-868-1690
Mailing address:
  • Phone: 614-623-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: