Healthcare Provider Details

I. General information

NPI: 1942246863
Provider Name (Legal Business Name): WORTHINGTON INDUSTRIES MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 DEARBORN DR
WORTHINGTON OH
43085-4767
US

IV. Provider business mailing address

1250 DEARBORN DR
COLUMBUS OH
43085-4767
US

V. Phone/Fax

Practice location:
  • Phone: 614-840-3571
  • Fax: 866-690-8967
Mailing address:
  • Phone: 614-840-3571
  • Fax: 866-690-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054-014393
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberOH299
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberP02500
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number64000225A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number254-043
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number4973
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number11168
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number22-02960
License Number StateKS
# 9
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0222116750
License Number StateOH
# 10
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number110732
License Number StateAL
# 11
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPH17473
License Number StateFL

VIII. Authorized Official

Name: KELLI CHILES
Title or Position: PHARMACY DIRECTOR
Credential: RPH
Phone: 614-840-3537