Organization
GRANTRIVERSIDE MEDICAL CARE FOUNDATION, INC
Active
Other names
OHIOHEALTH PRACTICE MANAGEMENT SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WUESTEWALD (DIRECTOR)
(614) 566-5643
Entity
Organization
Contact information
Practice address
3545 OLENTANGY RIVER RD, STE 501, COLUMBUS, OH 43214-3907
(614) 566-2714
(614) 566-2712
Mailing address
5350 FRANTZ RD, DUBLIN, OH 43016-4259
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
—
—
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OH
Enumeration date
11/16/2006
Last updated
07/23/2008
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