Organization
GRANT/RIVERSIDE MEDICAL CARE FOUNDATION, INC
Active
Parent organization
GRANT/RIVERSIDE MEDICAL CARE FOUNDATION, INC
Other names
MAX SPORTS
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANT/RIVERSIDE MEDICAL CARE FOUNDATION, INC
Authorized official
TRACY A HEDGES (CREDENTIALING SPECIALITS)
(614) 544-6356
Entity
Organization
Contact information
Practice address
3705 OLENTANGY RIVER RD, STE 260, COLUMBUS, OH 43214-3467
(614) 586-1220
(614) 586-1237
Mailing address
5350 FRANTZ RD, DUBLIN, OH 43016-4259
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OH
Enumeration date
12/11/2008
Last updated
12/11/2008
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