MEDICARE: OHIOHEALTH EMPLOYER SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363LF0000X	Family Nurse Practitioner
3	207Q00000X	Family Medicine Physician

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	:	1598289217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIOHEALTH EMPLOYER SERVICES, LLC

Provider Business Mailing Address
First Line	:	5450 FRANTZ RD STE 360
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-4141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4048
Country	:	US
Telephone Number	:	614-788-5280
Fax Number	:	614-788-5280

Authorized Official
Title or Position	:	CREDENTIALING SUPERVISOR
Name	:	HEATHER N HAINEY
Credential	:
Telephone Number	:	614-544-6161

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/30/2019

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