Healthcare Provider Details

I. General information

NPI: 1932538774
Provider Name (Legal Business Name): LOCAL PUBLIC HEALTH SERVICES COLLABORATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NORTHWOODS BLVD STE A
COLUMBUS OH
43235-4723
US

IV. Provider business mailing address

110 NORTHWOODS BLVD STE A
COLUMBUS OH
43235-4723
US

V. Phone/Fax

Practice location:
  • Phone: 614-781-9556
  • Fax: 614-781-9558
Mailing address:
  • Phone: 614-781-9556
  • Fax: 614-781-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. WAYNE P HOWLETT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 614-846-1911