MEDICARE: DAVID TIDWELL PA-C

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	363A00000X	Physician Assistant	50.008073RX	OH

General Provider Information

NPI Number	:	1528769486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID TIDWELL PA-C

Provider Business Mailing Address
First Line	:	2240 SEDGWICK DR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43220-5430
Country	:	US
Telephone Number	:	614-551-2186
Fax Number	:

Provider Business Practice Location Address
First Line	:	895 W 3RD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3106
Country	:	US
Telephone Number	:	614-437-0278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	04/28/2023

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Directions to “ DAVID TIDWELL PA-C” Practice Location

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