Basic Information
| Provider Information | |||||||||
| NPI: | 1912583469 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUBLIN INTEGRATED HEALTH CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4661 SAWMILL RD STE 3 | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432206123 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3535 FISHINGER BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | HILLIARD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430267500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407518233 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2021 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | THARP | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7407518233 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.