Provider Demographics
NPI:1497962732
Name:HILLIARD SQUARE DOCTOR'S OFFICE, INC.
Entity Type:Organization
Organization Name:HILLIARD SQUARE DOCTOR'S OFFICE, INC.
Other - Org Name:THE DOCTOR'S OFFICE AT HILLIARD SQUARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, MPAS
Authorized Official - Phone:614-771-8800
Mailing Address - Street 1:4600 LEAP CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1171
Mailing Address - Country:US
Mailing Address - Phone:614-771-8800
Mailing Address - Fax:614-771-8834
Practice Address - Street 1:4600 LEAP CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1171
Practice Address - Country:US
Practice Address - Phone:614-771-8800
Practice Address - Fax:614-771-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty