Provider Demographics
NPI:1073903431
Name:COLUMBUS WELLNESS MEDICINE, LLC
Entity Type:Organization
Organization Name:COLUMBUS WELLNESS MEDICINE, LLC
Other - Org Name:ELIZABETH TUTTLE,MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-420-2063
Mailing Address - Street 1:4889 SINCLAIR RD
Mailing Address - Street 2:SUITE #112
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5432
Mailing Address - Country:US
Mailing Address - Phone:614-420-2063
Mailing Address - Fax:614-505-6258
Practice Address - Street 1:4889 SINCLAIR RD
Practice Address - Street 2:SUITE #112
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5432
Practice Address - Country:US
Practice Address - Phone:614-420-2063
Practice Address - Fax:614-505-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty