Healthcare Provider Details

I. General information

NPI: 1568116317
Provider Name (Legal Business Name): HEART OF OHIO PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 W MAIN ST
NEWARK OH
43055-1345
US

IV. Provider business mailing address

1671 W MAIN ST
NEWARK OH
43055-1345
US

V. Phone/Fax

Practice location:
  • Phone: 614-297-1158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT FOUST
Title or Position: BUSINESS MANAGER
Credential:
Phone: 614-297-1158