Healthcare Provider Details

I. General information

NPI: 1871529149
Provider Name (Legal Business Name): WESTERVILLE PHYSICIAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 AGLER RD
COLUMBUS OH
43224-4523
US

IV. Provider business mailing address

2150 AGLER RD
COLUMBUS OH
43224-4523
US

V. Phone/Fax

Practice location:
  • Phone: 614-416-4325
  • Fax: 614-416-4320
Mailing address:
  • Phone: 614-416-4325
  • Fax: 614-416-4320

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: MRS. SANDRA WILLIS
Title or Position: FINANCE SUPERVISOR
Credential:
Phone: 614-546-4232