Organization
HEALTHSERVE PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C BOURLAND (CFO)
(614) 442-2431
Entity
Organization
Contact information
Practice address
5263 NIKE STATION WAY, HILLIARD, OH 43026-7449
(614) 876-2100
(614) 876-2120
Mailing address
2939 KENNY RD STE 200, COLUMBUS, OH 43221-2406
(614) 442-2431
(614) 442-2426
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
PT008883
OH
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1535534
STATE LICENSE
OH
Enumeration date
02/18/2014
Last updated
06/03/2014
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