| Gahanna Medical Practices Inc | |
|
4550 N Hamilton Rd Gahanna OH 43230 | |
| (614) 428-8200 | |
| (614) 428-9700 |
| Full Name | Gahanna Medical Practices Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4550 N Hamilton Rd, Gahanna, Ohio |
| Authorized Official Name and Position | Susan E Lake (PHYSICIAN) |
| Authorized Official Contact | 6144288200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gahanna Medical Practices Inc 4550 N Hamilton Rd Gahanna OH 43230 Ph: (614) 428-8200 | Gahanna Medical Practices Inc 4550 N Hamilton Rd Gahanna OH 43230 Ph: (614) 428-8200 |
| NPI Number | 1275603722 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 07/19/2012 |
| Medicare PECOS PAC ID | 6406875103 |
|---|---|
| Medicare Enrollment ID | O20051111000024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275603722 | NPI | - | NPPES |
| 0132412 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 34005856 (Ohio) | Primary |
| Provider Name | Susan E Lake |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306003835 PECOS PAC ID: 9537192653 Enrollment ID: I20120822000076 |
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