Organization
AETNA PROVIDER SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEMUNATU SHERIFF (INDEPENDENT PROVIDER)
(614) 946-5475
Entity
Organization
Contact information
Practice address
8514 ARLEN DRIVE, BLACKLICK, OH 43004
(614) 946-5475
Mailing address
8514 ARLEN DR, BLACKLICK, OH 43004-8155
(614) 946-5475
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
2366658
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2366658
—
OH
Enumeration date
01/22/2015
Last updated
01/22/2015
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