Provider Demographics
NPI:1588666887
Name:FAMILY PRACTICE CENTER OF WESTERVILLE, INC
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER OF WESTERVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-882-2349
Mailing Address - Street 1:190 S STATE ST
Mailing Address - Street 2:STE A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2200
Mailing Address - Country:US
Mailing Address - Phone:614-882-2349
Mailing Address - Fax:614-882-9005
Practice Address - Street 1:190 S STATE ST
Practice Address - Street 2:STE A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2200
Practice Address - Country:US
Practice Address - Phone:614-882-2349
Practice Address - Fax:614-882-9005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL OHIO PRIMARY CARE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-01
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0695494Medicaid
OHD89770Medicare UPIN
OH0695494Medicaid
OHE00671Medicare UPIN
OHFA9926001Medicare ID - Type Unspecified