Healthcare Provider Details

I. General information

NPI: 1932394863
Provider Name (Legal Business Name): PICKAWAY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9085 SOUTHERN ST BERGER MEDICAL CENTER AT S. R. 104, SUITE D
ORIENT OH
43146
US

IV. Provider business mailing address

9085 SOUTHERN ST BERGER MEDICAL CENTER AT S. R. 104, SUITE D
ORIENT OH
43146
US

V. Phone/Fax

Practice location:
  • Phone: 614-277-4654
  • Fax:
Mailing address:
  • Phone: 614-277-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. WENDY C ELLIOTT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 740-420-8078