| North Creek Llc | |
|
4461 Broadway Ste 100 Grove City OH 43123-3064 | |
| (614) 594-2141 | |
| Not Available |
| Full Name | North Creek Llc |
|---|---|
| Speciality | General Practice |
| Location | 4461 Broadway Ste 100, Grove City, Ohio |
| Authorized Official Name and Position | Brian Dean (CEO) |
| Authorized Official Contact | 6147065206 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Creek Llc 4461 Broadway Ste 100 Grove City OH 43123-3064 Ph: () - | North Creek Llc 4461 Broadway Ste 100 Grove City OH 43123-3064 Ph: (614) 594-2141 |
| NPI Number | 1457858797 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 04/24/2018 |
| Medicare PECOS PAC ID | 4284989377 |
|---|---|
| Medicare Enrollment ID | O20180613001263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457858797 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
| Provider Name | Angel L Villanueva |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1255370714 PECOS PAC ID: 4284620527 Enrollment ID: I20040422000855 |
| Provider Name | Jobeth Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225325210 PECOS PAC ID: 3476788332 Enrollment ID: I20150831001724 |
| Provider Name | Wayne Cummings |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1902832868 PECOS PAC ID: 6002198009 Enrollment ID: I20170127001143 |
| Provider Name | Charley Allen Roman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063968469 PECOS PAC ID: 7719109008 Enrollment ID: I20180712001608 |
| Provider Name | Leslie Marie Stegall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356875397 PECOS PAC ID: 3971854720 Enrollment ID: I20180918003928 |
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