Healthcare Provider Details

I. General information

NPI: 1427127919
Provider Name (Legal Business Name): OSU INTERNAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 STONERIDGE LN
DUBLIN OH
43017-2009
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-5001
  • Fax:
Mailing address:
  • Phone: 614-685-4601
  • Fax: 614-366-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ANN CLOUSE
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 614-685-4601