Healthcare Provider Details

I. General information

NPI: 1710297288
Provider Name (Legal Business Name): MOUNT CARMEL HEALTH PROVIDERS III, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 REFUGEE ROAD
COLUMBUS OH
43232-4814
US

IV. Provider business mailing address

6150 EAST BROAD STREET 2ND FLOOR WH 233
COLUMBUS OH
43213-1574
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-4039
  • Fax: 614-235-4021
Mailing address:
  • Phone: 614-546-4400
  • Fax: 614-546-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA RICHARDSON
Title or Position: COORDINATOR
Credential:
Phone: 614-546-4969