Provider Demographics
NPI:1710285812
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:DIRECTOR 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 1:300 POLARIS PKWY STE 2150
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7808
Practice Address - Country:US
Practice Address - Phone:614-588-0020
Practice Address - Fax:614-588-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2083347Medicaid
OH2083347Medicaid