Provider Demographics
NPI:1174657035
Name:REYNOLDSBURG INTERNAL MEDICINE,INC
Entity Type:Organization
Organization Name:REYNOLDSBURG INTERNAL MEDICINE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-864-8500
Mailing Address - Street 1:7657 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1243
Mailing Address - Country:US
Mailing Address - Phone:614-864-8500
Mailing Address - Fax:614-864-8646
Practice Address - Street 1:7657 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1243
Practice Address - Country:US
Practice Address - Phone:614-864-8500
Practice Address - Fax:614-864-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty