Organization
HEALTHSERVE MEDICAL GROUP LLC
Active
Organization
HEALTHSERVE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C BOURLAND (PRESIDENT)
(614) 442-2431
Entity
Organization
Contact information
Practice address
445 ROCKY FORK BLVD STE A, GAHANNA, OH 43230-3336
(614) 442-2431
(614) 442-2426
Mailing address
2939 KENNY RD STE 200, COLUMBUS, OH 43221-2406
(614) 442-2431
(614) 442-2426
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153534
BUSINESS LICENSE
OH
Enumeration date
10/13/2014
Last updated
10/13/2014
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