Provider Demographics
NPI:1407909385
Name:GROVE CITY INTERNAL MEDICINE
Entity Type:Organization
Organization Name:GROVE CITY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-875-9900
Mailing Address - Street 1:3055 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2751
Mailing Address - Country:US
Mailing Address - Phone:614-875-9900
Mailing Address - Fax:
Practice Address - Street 1:3055 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2751
Practice Address - Country:US
Practice Address - Phone:614-875-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH52244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB8037Medicare ID - Type UnspecifiedRAILROAD MEDICARE