Provider Demographics
NPI:1518588185
Name:DOMINION HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:DOMINION HEALTH SERVICES INC.
Other - Org Name:DOMINION QWIKSTOP CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGOE-OPOKU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:614-209-9340
Mailing Address - Street 1:2511 W SCHROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8956
Mailing Address - Country:US
Mailing Address - Phone:614-209-9340
Mailing Address - Fax:
Practice Address - Street 1:2511 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8956
Practice Address - Country:US
Practice Address - Phone:614-209-9340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care