Provider Demographics
NPI:1417337460
Name:FAMILY PRACTICE WEST, INC.
Entity Type:Organization
Organization Name:FAMILY PRACTICE WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUTHEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-878-7285
Mailing Address - Street 1:5212 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1642
Mailing Address - Country:US
Mailing Address - Phone:614-878-7285
Mailing Address - Fax:
Practice Address - Street 1:5212 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1642
Practice Address - Country:US
Practice Address - Phone:614-878-7285
Practice Address - Fax:614-878-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17302 COA-NP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA68402Medicare UPIN