| Garth Heasley Llc | |
|
1943 W 5th Ave Columbus OH 43212-1902 | |
| (614) 477-8257 | |
| Not Available |
| Full Name | Garth Heasley Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1943 W 5th Ave, Columbus, Ohio |
| Authorized Official Name and Position | Garth Heasley (OWNER) |
| Authorized Official Contact | 6144778257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Garth Heasley Llc 297 Ravine Ridge Dr N Powell OH 43065-9352 Ph: (614) 477-8257 | Garth Heasley Llc 1943 W 5th Ave Columbus OH 43212-1902 Ph: (614) 477-8257 |
| NPI Number | 1548709306 |
|---|---|
| Provider Enumeration Date | 02/13/2017 |
| Last Update Date | 02/13/2017 |
| Medicare PECOS PAC ID | 4183908858 |
|---|---|
| Medicare Enrollment ID | O20170223001846 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548709306 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | I.1700034 (Ohio) | Primary |
| Provider Name | Garth Heasley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548647969 PECOS PAC ID: 5092099762 Enrollment ID: I20170223001902 |
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