Healthcare Provider Details

I. General information

NPI: 1669655593
Provider Name (Legal Business Name): KIMBERLY SCANSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4867
  • Fax: 614-722-4380
Mailing address:
  • Phone: 614-722-4867
  • Fax: 614-722-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35085761
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: