Healthcare Provider Details

I. General information

NPI: 1538177183
Provider Name (Legal Business Name): WEST CENTRAL OHIO CARDIOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST SUITE 210
LIMA OH
45801-3990
US

IV. Provider business mailing address

770 W HIGH ST SUITE 210
LIMA OH
45801-3990
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-3828
  • Fax: 419-224-5394
Mailing address:
  • Phone: 419-222-3828
  • Fax: 419-224-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35046616
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5734614
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerAETNA
# 2
Identifier2070842
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: DR. JAMES SCOTT WOLERY
Title or Position: PRESIDENT
Credential: MD
Phone: 419-222-3828