Healthcare Provider Details

I. General information

NPI: 1194071597
Provider Name (Legal Business Name): WESTERVILLE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 W SCHROCK RD
WESTERVILLE OH
43081-2890
US

IV. Provider business mailing address

191 W SCHROCK RD
WESTERVILLE OH
43081-2890
US

V. Phone/Fax

Practice location:
  • Phone: 614-384-0800
  • Fax: 614-384-0801
Mailing address:
  • Phone: 614-384-0800
  • Fax: 614-384-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number34003140
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT J BROOKS
Title or Position: CEO/OWNER
Credential:
Phone: 614-384-0800