MEDICARE: FIRST CARE INTEGRATED HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207QA0401X	Addiction Medicine (Family Medicine) Physician
2	363LF0000X	Family Nurse Practitioner
3	363LP2300X	Primary Care Nurse Practitioner
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447884077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CARE INTEGRATED HEALTH LLC

Provider Business Mailing Address
First Line	:	6167 BUCKEYE PKWY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8387
Country	:	US
Telephone Number	:	614-493-9884
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 E MAIN ST STE 102
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2441
Country	:	US
Telephone Number	:	614-226-5622
Fax Number	:

Authorized Official
Title or Position	:	NP/CEO
Name	:	FANTA BERETAY
Credential	:	CNP
Telephone Number	:	614-226-5622

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	06/30/2023

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