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General NPI Number Information
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NPI Number | 1932273273
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Entity Type | Organization
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Legal Business Name | MIDTOWNE FAMILY PRACTICE CENTRE, LLC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 421 GEORGESVILLE RD
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City | COLUMBUS
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State | OH
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Zip | 43228
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Country | US
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Telephone | 614-272-7700
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Fax | 614-272-2728
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Provider Business Mailing Address
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Address Line | 421 GEORGESVILLE RD
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City | COLUMBUS
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State | OH
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Zip | 43228
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Country | US
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Telephone | 614-272-7700
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Fax | 614-272-2728
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Authorized Official
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Title or Position | DOCTOR
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Name | MR. CHARLES JAMES KISTLER JR.
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Credential | DO
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Telephone | 614-272-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2242
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License Number State | OH
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