Provider Demographics
NPI:1083809909
Name:PICKAWAY HEALTH SERVICES
Entity Type:Organization
Organization Name:PICKAWAY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-420-8078
Mailing Address - Street 1:9085 SOUTHERN STREET AT S. R. 104
Mailing Address - Street 2:BERGER MEDICAL CENTER
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146
Mailing Address - Country:US
Mailing Address - Phone:614-277-4618
Mailing Address - Fax:
Practice Address - Street 1:9085 SOUTHERN STREET AT S. R. 104
Practice Address - Street 2:BERGER MEDICAL CENTER
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146
Practice Address - Country:US
Practice Address - Phone:614-277-4618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service