Provider Demographics
NPI:1497482111
Name:OH INDEPENDENT MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:OH INDEPENDENT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS, POPULATION HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:614-544-4458
Mailing Address - Street 1:3430 OHIOHEALTH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202
Mailing Address - Country:US
Mailing Address - Phone:614-566-0152
Mailing Address - Fax:
Practice Address - Street 1:3430 OHIO HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1575
Practice Address - Country:US
Practice Address - Phone:614-566-0152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty