Organization
COLUMBUS CHRONIC CARE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MULLLISSA CHILDRESS FNP (CEO)
(614) 496-8420
Entity
Organization
Contact information
Practice address
506 MCCUTCHEON RD, GAHANNA, OH 43230-5001
(614) 496-8420
Mailing address
5300 BRIGHT SUN CT, LAS VEGAS, NV 89130-3728
(614) 496-8420
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
16446-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0129662
—
OH
Enumeration date
04/24/2015
Last updated
07/21/2022
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