Healthcare Provider Details

I. General information

NPI: 1134822075
Provider Name (Legal Business Name): TOTAL CARE CONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 KEEP PL
COLUMBUS OH
43204-4989
US

IV. Provider business mailing address

2331 KEEP PL
COLUMBUS OH
43204-4989
US

V. Phone/Fax

Practice location:
  • Phone: 614-407-1614
  • Fax:
Mailing address:
  • Phone: 614-407-1614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAYVEER SODIWAL
Title or Position: CREDENTIALING
Credential:
Phone: 614-407-1614