Provider Demographics
NPI:1871913731
Name:MOUNT CARMEL - OSU PHYSICIAN ALLIANCE LLC
Entity type:Organization
Organization Name:MOUNT CARMEL - OSU PHYSICIAN ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CODING & REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORNSIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-685-1511
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2391
Mailing Address - Fax:614-293-4359
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1170
Practice Address - Country:US
Practice Address - Phone:740-845-7500
Practice Address - Fax:740-845-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty