Healthcare Provider Details

I. General information

NPI: 1033228226
Provider Name (Legal Business Name): NORTHWEST PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7275 SAWMILL RD
DUBLIN OH
43016-9021
US

IV. Provider business mailing address

7275 SAWMILL RD
DUBLIN OH
43016-9021
US

V. Phone/Fax

Practice location:
  • Phone: 614-766-6321
  • Fax: 614-766-0193
Mailing address:
  • Phone: 614-766-6321
  • Fax: 614-766-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32028199
License Number StateOH

VIII. Authorized Official

Name: JOSEPH H BANKS
Title or Position: PRESIDENT
Credential: MD
Phone: 614-766-4859