Provider Demographics
NPI:1508991001
Name:WEST JEFFERSON FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:WEST JEFFERSON FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-879-6770
Mailing Address - Street 1:2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1202
Mailing Address - Country:US
Mailing Address - Phone:614-879-6770
Mailing Address - Fax:614-879-7067
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1202
Practice Address - Country:US
Practice Address - Phone:614-879-6770
Practice Address - Fax:614-879-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWE9324711Medicare PIN