=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558739862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIOHEALTH NEUROLOGICAL PHISICIANS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2015
-----------------------------------------------------
Last Update Date | 09/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3555 OLENTANGY RIVER RD 2002
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-788-2450
-----------------------------------------------------
Fax | 614-788-2494
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 FRANTZ RD 250
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43016-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-544-6210
-----------------------------------------------------
Fax | 614-544-6370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALS COORDINATOR
-----------------------------------------------------
Name | MARY HAMMOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-544-6210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------