Provider Demographics
NPI:1467873406
Name:OHIO STATE FAST CARE
Entity Type:Organization
Organization Name:OHIO STATE FAST CARE
Other - Org Name:OHIO STATE FASTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CORPORATE CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-293-7444
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:STE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3693
Mailing Address - Fax:
Practice Address - Street 1:3061 KINGSDALE CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2009
Practice Address - Country:US
Practice Address - Phone:614-366-2050
Practice Address - Fax:614-293-5167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSU FAMILY PRACTICE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-18
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9304575Medicare PIN