MEDICARE: COLUMBUS INTEGRATIVE FAMILY MEDICINE CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	350922171	OH

General Provider Information

NPI Number	:	1457700684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS INTEGRATIVE FAMILY MEDICINE CENTER LLC

Provider Business Mailing Address
First Line	:	453 WATERBURY CT
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:	614-515-5244
Fax Number	:	614-515-5757

Provider Business Practice Location Address
First Line	:	453 WATERBURY CT
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-5309
Country	:	US
Telephone Number	:	614-515-5244
Fax Number	:	614-515-5757

Authorized Official
Title or Position	:	OWNER
Name	:	RUSLANA KURPITA
Credential	:	MD
Telephone Number	:	614-306-7140

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	11/08/2016

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