MEDICARE: METHODIST ELDERCARE PHYSICIAN SERVICES 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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1881093458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST ELDERCARE PHYSICIAN SERVICES INC.

Provider Business Mailing Address
First Line	:	155 FENWAY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1407
Country	:	US
Telephone Number	:	614-888-7492
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 FENWAY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1407
Country	:	US
Telephone Number	:	614-888-7492
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. ROBERT WEHNER
Credential	:
Telephone Number	:	614-888-7492

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	10/21/2015

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