Basic Information
| Provider Information | |||||||||
| NPI: | 1154915528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WORTHINGTON INTEGRATED PAIN & WELLNESS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 WORTHINGTON WOODS BLVD | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430855713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403866580 | ||||||||
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| Practice Location | |||||||||
| Address1: | 720 WORTHINGTON WOODS BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430855713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403866580 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2021 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | SCOT | ||||||||
| AuthorizedOfficialMiddleName: | MATTHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7403866580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.