Provider Demographics
NPI:1215034434
Name:GRANDVIEW FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:GRANDVIEW FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-488-7929
Mailing Address - Street 1:1550 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2495
Mailing Address - Country:US
Mailing Address - Phone:614-488-7929
Mailing Address - Fax:614-488-3201
Practice Address - Street 1:1550 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2495
Practice Address - Country:US
Practice Address - Phone:614-488-7929
Practice Address - Fax:614-488-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0913097Medicaid
OH=========00OtherBUREAU OF WORKERS COMPENS
OHGR9277131Medicare ID - Type Unspecified