Healthcare Provider Details

I. General information

NPI: 1346497989
Provider Name (Legal Business Name): GRANT SCOPE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E BROAD ST 1ST FLOOR
COLUMBUS OH
43215-3946
US

IV. Provider business mailing address

700 E BROAD ST 1ST FLOOR
COLUMBUS OH
43215-3946
US

V. Phone/Fax

Practice location:
  • Phone: 614-917-1670
  • Fax: 614-947-3991
Mailing address:
  • Phone: 614-917-1670
  • Fax: 614-947-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0928AS
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number0928AS
License Number StateOH

VIII. Authorized Official

Name: DR. GORDON KIM
Title or Position: BOARD PRESIDENT
Credential: D.O.
Phone: 614-458-1183