Organization
FORM AND FUNCTION HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN P BELL II (VP FINANCE)
(419) 235-2823
Entity
Organization
Contact information
Practice address
4278 INDIANOLA AVE, COLUMBUS, OH 43214-2806
(419) 235-2823
Mailing address
4278 INDIANOLA AVE, COLUMBUS, OH 43214-2806
(419) 235-2823
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
02/12/2025
Last updated
03/10/2025
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