Basic Information
| Provider Information | |||||||||
| NPI: | 1427468289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 793 W STATE ST. | ||||||||
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| City: | ST. COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43222 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 477 COOPER RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148988714 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2014 | ||||||||
| LastUpdateDate: | 05/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6147468134 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRINITY HEALTH | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.