Healthcare Provider Details

I. General information

NPI: 1316904436
Provider Name (Legal Business Name): OHIO STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ZOLLINGER RD 4TH FL
COLUMBUS OH
43221-2849
US

IV. Provider business mailing address

700 ACKERMAN RD STE 570
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2222
  • Fax: 614-293-2200
Mailing address:
  • Phone: 614-293-3693
  • Fax: 614-293-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNE SMITH
Title or Position: DIRECTOR, CORPORATE CREDENTIALING
Credential:
Phone: 614-293-7444