Healthcare Provider Details

I. General information

NPI: 1558769968
Provider Name (Legal Business Name): TORNIK FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N CHILLICOTHE ST
PLAIN CITY OH
43064-1045
US

IV. Provider business mailing address

209 N CHILLICOTHE ST
PLAIN CITY OH
43064-1045
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-6700
  • Fax: 614-873-6790
Mailing address:
  • Phone: 614-873-6700
  • Fax: 614-873-6790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JENNIFER JONES
Title or Position: BILLING ADMINISTRATOR
Credential: CMRS
Phone: 614-864-9560