MEDICARE: WHITEHALL PREPARATORY & FITNESS ACADEMY

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1649556648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITEHALL PREPARATORY & FITNESS ACADEMY

Provider Business Mailing Address
First Line	:	3474 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3474 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2219
Country	:	US
Telephone Number	:	937-684-2501
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	TOBY PINKERTON
Credential	:
Telephone Number	:	937-684-2501

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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