Provider Demographics
NPI:1528204138
Name:R KEITH PATTISON DO INC
Entity Type:Organization
Organization Name:R KEITH PATTISON DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PATTISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-227-0123
Mailing Address - Street 1:750 MT CARMEL MALL STE 310
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-227-0123
Mailing Address - Fax:614-227-0270
Practice Address - Street 1:750 MT CARMEL MALL
Practice Address - Street 2:STE 350
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1553
Practice Address - Country:US
Practice Address - Phone:614-227-0123
Practice Address - Fax:614-227-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH342598000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicare PIN