MEDICARE: AFFORDABLE CARE HEALTH CLINIC

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	363LF0000X	Family Nurse Practitioner		OH

General Provider Information

NPI Number	:	1801148549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE CARE HEALTH CLINIC

Provider Business Mailing Address
First Line	:	104 N STYGLER RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-2437
Country	:	US
Telephone Number	:	614-475-2273
Fax Number	:	614-475-4329

Provider Business Practice Location Address
First Line	:	104 N STYGLER RD
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-2437
Country	:	US
Telephone Number	:	614-475-2273
Fax Number	:	614-475-4329

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REBECCA SHAW
Credential	:
Telephone Number	:	614-475-2273

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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Directions to “AFFORDABLE CARE HEALTH CLINIC ” Practice Location

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