Provider Demographics
NPI:1831295450
Name:PICKAWAY HEALTH SERVICES
Entity Type:Organization
Organization Name:PICKAWAY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-420-8078
Mailing Address - Street 1:617 LANCASTER PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-8826
Mailing Address - Country:US
Mailing Address - Phone:740-420-8078
Mailing Address - Fax:740-477-3594
Practice Address - Street 1:6024 HOOVER RD
Practice Address - Street 2:SUITE F
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8133
Practice Address - Country:US
Practice Address - Phone:614-871-3121
Practice Address - Fax:614-871-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054838261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9296168Medicare ID - Type Unspecified