Basic Information
| Provider Information | |||||||||
| NPI: | 1558702662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONWIDE CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 584 COUNTY LINE RD W | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430827245 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 584 COUNTY LINE RD W | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430827245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143556000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 07/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | KULJU | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPORTS MEDICINE CORRDINATOR FOR OUT | ||||||||
| AuthorizedOfficialTelephone: | 6143556019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS, ATC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.