Basic Information
| Provider Information | |||||||||
| NPI: | 1255921326 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST CHILDREN'S COMMUNITY PRACTICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CHILDRENS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147222000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7629 KINGS POINTE RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436171514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198416442 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2021 | ||||||||
| LastUpdateDate: | 01/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6147224550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NATIONWIDE CHILDREN'S HOSPITAL | ||||||||
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| NPICertificationDate: | 01/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.