Healthcare Provider Details

I. General information

NPI: 1467597401
Provider Name (Legal Business Name): OHIO REPRODUCTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 KNIGHTSBRIDGE BLVD STE E
COLUMBUS OH
43214-2300
US

IV. Provider business mailing address

4830 KNIGHTSBRIDGE BLVD STE E
COLUMBUS OH
43214-2300
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-2280
  • Fax: 614-451-4352
Mailing address:
  • Phone: 614-451-2280
  • Fax: 614-451-4352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAM S MERRITT
Title or Position: BILLING MANAGER
Credential:
Phone: 614-451-2280