Healthcare Provider Details

I. General information

NPI: 1639264351
Provider Name (Legal Business Name): CENTRAL OHIO FAMILY PHYSICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 BROADWAY
GROVE CITY OH
43123-2202
US

IV. Provider business mailing address

3636 BROADWAY
GROVE CITY OH
43123-2202
US

V. Phone/Fax

Practice location:
  • Phone: 614-871-3234
  • Fax: 614-871-1494
Mailing address:
  • Phone: 614-871-3234
  • Fax: 614-871-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number57620
License Number StateOH

VIII. Authorized Official

Name: MATTHEW COOK
Title or Position: PHYSICIAN
Credential:
Phone: 614-871-3234