Provider Demographics
NPI:1568173193
Name:OSU FAMILY PRACTICE SERVICES
Entity Type:Organization
Organization Name:OSU FAMILY PRACTICE SERVICES
Other - Org Name:THE OHIO STATE UNIVERSITY TOTAL HEALTH AND WELLNESS AT ST. VINCENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-685-9994
Mailing Address - Street 1:181 TAYLOR AVE STE 1203
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1779
Mailing Address - Country:US
Mailing Address - Phone:937-631-0638
Mailing Address - Fax:614-685-9993
Practice Address - Street 1:1490 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2140
Practice Address - Country:US
Practice Address - Phone:614-685-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSU FAMILY PRACTICE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-05
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0009398Medicaid