Healthcare Provider Details

I. General information

NPI: 1073723276
Provider Name (Legal Business Name): OHIO STATE UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

173 MACDOUGALL LN
BLACKLICK OH
43004-9317
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2385
  • Fax: 614-293-3066
Mailing address:
  • Phone: 614-499-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT09715
License Number StateOH

VIII. Authorized Official

Name: MISS MELISSA FAYE CONVERSE
Title or Position: STAFF PHYSICAL THERAPIST
Credential: PT, ATC
Phone: 614-293-2385