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Organization
OHIOHEALTH CORPORATION
Active
Organization
OHIOHEALTH CORPORATION
Active
Other names
Grant/Riverside Medical Care Foundation, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WUESTEWALD (DIRECTOR OF REVENUE CYCLE)
(614) 544-6351
Entity
Organization
Contact information
Practice address
300 POLARIS PKWY STE 2150, WESTERVILLE, OH 43082-7808
(614) 588-0020
(614) 588-2031
Mailing address
5350 FRANTZ RD, DUBLIN, OH 43016-4259
(614) 544-6356
(614) 544-6370
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2083347
—
OH
Enumeration date
03/14/2011
Last updated
03/14/2011
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