Organization
GRANT/RIVERSIDE MEDICAL CARE FOUNDATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS WILKINS (OHMSF CREDENTIALING COORDINATOR)
(614) 544-6382
Entity
Organization
Contact information
Practice address
111 S. GRANT AVE, COLUMBUS, OH 43215
(614) 566-9160
Mailing address
5350 FRANTZ RD., STE 250, DUBLIN, OH 43016
(614) 544-6382
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
13750
OH
363LA2100X
Acute Care Nurse Practitioner
Primary
COA13750NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13750-NP
CERTIFICATE OF AUTHORITY
OH
Enumeration date
09/21/2012
Last updated
10/05/2012
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