Provider Demographics
NPI:1487868279
Name:MOUNT CARMEL HEALTHPROVDERS INC
Entity Type:Organization
Organization Name:MOUNT CARMEL HEALTHPROVDERS INC
Other - Org Name:HERITAGE FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-546-4621
Mailing Address - Street 1:6150 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1574
Mailing Address - Country:US
Mailing Address - Phone:614-546-4400
Mailing Address - Fax:614-546-4441
Practice Address - Street 1:3617 HERITAGE CLUB DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1313
Practice Address - Country:US
Practice Address - Phone:614-777-5530
Practice Address - Fax:614-777-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty