MEDICARE: CENTRAL OHIO NUTRITION CENTER 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	133V00000X	Registered Dietitian
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1962654749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL OHIO NUTRITION CENTER INC

Provider Business Mailing Address
First Line	:	4191 KELNOR DR
Second Line	:	SUITE 200
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3990
Country	:	US
Telephone Number	:	614-277-4893
Fax Number	:

Provider Business Practice Location Address
First Line	:	4191 KELNOR DR
Second Line	:	SUITE 200
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3990
Country	:	US
Telephone Number	:	614-277-4893
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JUDY F LOPER
Credential	:	PHD, RD
Telephone Number	:	614-864-7225

Provider Enumeration Date	:	10/12/2008
Last Update Date	:	10/12/2008

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