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General NPI Number Information
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NPI Number | 1184793002
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Entity Type | Organization
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Legal Business Name | PICKAWAY PROFESSIONAL SERVICES INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 600 N PICKAWAY ST
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City | CIRCLEVILLE
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State | OH
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Zip | 43113-1447
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Country | US
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Telephone | 740-474-2124
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Fax | 614-552-0068
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Provider Business Mailing Address
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Address Line | PO BOX 71-4823
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City | COLUMBUS
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State | OH
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Zip | 43271-4823
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Country | US
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Telephone | 614-552-0061
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Fax | 614-552-0168
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Authorized Official
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Title or Position | MD/EXECUTIVE DIRECTOR
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Name | KEITH HOLTEN
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Credential | MD
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Telephone | 614-552-0061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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