MEDICARE: WESTERVILLE PHYSICIAN INC.

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

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
2	0113230	OTHER	OH	UNITED HEALTH CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871529149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERVILLE PHYSICIAN INC.

Provider Business Mailing Address
First Line	:	2150 AGLER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4523
Country	:	US
Telephone Number	:	614-416-4325
Fax Number	:	614-416-4320

Provider Business Practice Location Address
First Line	:	2150 AGLER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4523
Country	:	US
Telephone Number	:	614-416-4325
Fax Number	:	614-416-4320

Authorized Official
Title or Position	:	FINANCE SUPERVISOR
Name	:	MRS. SANDRA WILLIS
Credential	:
Telephone Number	:	614-546-4232

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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Directions to “WESTERVILLE PHYSICIAN INC. ” Practice Location

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