1699046391 NPI number — CRESTLINE MEDICAL CENTER LLC

Table of content: (NPI 1699046391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699046391 NPI number — CRESTLINE MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRESTLINE MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
URGENT CARE PHYSICIANS CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699046391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 WORTHINGTON WOODS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORTHINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43085-5713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-785-4700
Provider Business Mailing Address Fax Number:
614-638-7348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 WORTHINGTON WOODS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORTHINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43085-5713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-785-4700
Provider Business Practice Location Address Fax Number:
614-638-7348
Provider Enumeration Date:
01/26/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AKUSOBA
Authorized Official First Name:
ARINZE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
614-785-4700

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)