| Whitehall Medical Center Inc | |
|
4254 East Main Street Columbus OH 43213 | |
| (614) 235-9944 | |
| (614) 235-9344 |
| Full Name | Whitehall Medical Center Inc |
|---|---|
| Speciality | General Practice |
| Location | 4254 East Main Street, Columbus, Ohio |
| Authorized Official Name and Position | Elmer F Diltz (OWNER) |
| Authorized Official Contact | 6142359944 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whitehall Medical Center Inc 4254 East Main Street Columbus OH 43213 Ph: (614) 235-9944 | Whitehall Medical Center Inc 4254 East Main Street Columbus OH 43213 Ph: (614) 235-9944 |
| NPI Number | 1487795795 |
|---|---|
| Provider Enumeration Date | 02/09/2007 |
| Last Update Date | 12/06/2012 |
| Medicare PECOS PAC ID | 6103850086 |
|---|---|
| Medicare Enrollment ID | O20050920001171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487795795 | NPI | - | NPPES |
| 0198647 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Elmer F Diltz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104877042 PECOS PAC ID: 8820114721 Enrollment ID: I20100929000006 |
| Provider Name | Lisa D Cline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467866814 PECOS PAC ID: 6800012881 Enrollment ID: I20140728002482 |
| Provider Name | Jenice R Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437601341 PECOS PAC ID: 8628359221 Enrollment ID: I20161219001678 |
| Provider Name | Sara Jo Doran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043705387 PECOS PAC ID: 5496005852 Enrollment ID: I20180905002044 |
| Provider Name | Shauna Marlowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588202048 PECOS PAC ID: 2264874486 Enrollment ID: I20240520002570 |
| Provider Name | Marcus E Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851137400 PECOS PAC ID: 4486191582 Enrollment ID: I20240807002217 |
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