Provider Demographics
NPI:1871529149
Name:WESTERVILLE PHYSICIAN INC.
Entity type:Organization
Organization Name:WESTERVILLE PHYSICIAN INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4232
Mailing Address - Street 1:2150 AGLER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4523
Mailing Address - Country:US
Mailing Address - Phone:614-416-4325
Mailing Address - Fax:614-416-4320
Practice Address - Street 1:2150 AGLER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4523
Practice Address - Country:US
Practice Address - Phone:614-416-4325
Practice Address - Fax:614-416-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2493289Medicaid
OH0113230OtherUNITED HEALTH CARE
OH2550645Medicaid
OH2550645Medicaid