Provider Demographics
NPI:1700948155
Name:POLARIS PARKWAY INTERNAL MEDICINE & PEDIATRICS, LTD
Entity Type:Organization
Organization Name:POLARIS PARKWAY INTERNAL MEDICINE & PEDIATRICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARRIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNCIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-865-4800
Mailing Address - Street 1:110 POLARIS PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8024
Mailing Address - Country:US
Mailing Address - Phone:614-865-4800
Mailing Address - Fax:614-865-4900
Practice Address - Street 1:110 POLARIS PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8024
Practice Address - Country:US
Practice Address - Phone:614-865-4800
Practice Address - Fax:614-865-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG08792Medicare UPIN
OHI39741Medicare UPIN
OHG13114Medicare UPIN