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1730 S High St Columbus OH 43207-1862 | |
| (520) 524-6084 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1730 S High St, Columbus, Ohio |
| Authorized Official Name and Position | Orlando Carter (CEO) |
| Authorized Official Contact | 7319359267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1730 S High St Columbus OH 43207-1862 Ph: (520) 524-6084 | 1730 S High St Columbus OH 43207-1862 Ph: (520) 524-6084 |
| NPI Number | 1649733445 |
|---|---|
| Provider Enumeration Date | 04/09/2019 |
| Last Update Date | 04/26/2024 |
| Certification Date | 04/26/2024 |
| Medicare PECOS PAC ID | 4981147014 |
|---|---|
| Medicare Enrollment ID | O20240618001722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649733445 | NPI | - | NPPES |
| Provider Name | Laura Patrice Banks Starks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508466939 PECOS PAC ID: 3476096512 Enrollment ID: I20240618001966 |
| Provider Name | Caress L Loftin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730691239 PECOS PAC ID: 0446795140 Enrollment ID: I20240717001183 |
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