Healthcare Provider Details

I. General information

NPI: 1801961057
Provider Name (Legal Business Name): POWELL PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CLAIREDAN DR.
POWELL OH
43065
US

IV. Provider business mailing address

55 CLAIREDAN DR.
POWELL OH
43065
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-8989
  • Fax: 614-888-8968
Mailing address:
  • Phone: 614-888-8989
  • Fax: 614-888-8968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number350830708
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number350814830
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35055409H
License Number StateOH

VIII. Authorized Official

Name: DEB HOWELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 614-888-8989