Provider Demographics
NPI:1780875070
Name:WORTHINGTON INDUSTRIES MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:WORTHINGTON INDUSTRIES MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:COWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-840-3500
Mailing Address - Street 1:1250 DEARBORN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4767
Mailing Address - Country:US
Mailing Address - Phone:614-840-3500
Mailing Address - Fax:614-840-3510
Practice Address - Street 1:1250 DEARBORN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-4767
Practice Address - Country:US
Practice Address - Phone:614-840-3500
Practice Address - Fax:614-840-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0180861Medicaid
OHOH84035Medicaid
OH0654297Medicaid
OHCA0753513Medicare PIN
OHF72002Medicare UPIN
OHA16809Medicare UPIN
OHOH84035Medicaid
OH0180861Medicaid
OH0654297Medicaid