Healthcare Provider Details

I. General information

NPI: 1548601818
Provider Name (Legal Business Name): CHALMERS P. WYLIE , AMBULATORY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5498
  • Fax: 614-257-5205
Mailing address:
  • Phone: 614-257-5498
  • Fax: 614-257-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License NumberS.0900647
License Number StateOH

VIII. Authorized Official

Name: MRS. ANNIE N. JONES
Title or Position: SOCIAL WORKER/MENTAL HEALTH
Credential: MSW, LSW
Phone: 614-257-5498