Provider Demographics
NPI:1528367562
Name:OHIOHEALTH CORPORATION
Entity Type:Organization
Organization Name:OHIOHEALTH CORPORATION
Other - Org Name:GRANT/RIVERSIDE MEDICAL CARE FOUNDATION, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRCTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WUESTEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-544-6351
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:614-544-6356
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:5131 BEACON HILL RD STE 160
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4441
Practice Address - Country:US
Practice Address - Phone:614-544-2815
Practice Address - Fax:614-544-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2083347Medicaid
OH2083347Medicaid