| Capital City Regenerative Medicine Llc | |
|
5577 N High St Ste B Worthington OH 43085-3939 | |
| (614) 436-3870 | |
| Not Available |
| Full Name | Capital City Regenerative Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5577 N High St Ste B, Worthington, Ohio |
| Authorized Official Name and Position | Brian Schuetz (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6144363870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital City Regenerative Medicine Llc 5577 N High St Ste B Worthington OH 43085-3939 Ph: (614) 436-3870 | Capital City Regenerative Medicine Llc 5577 N High St Ste B Worthington OH 43085-3939 Ph: (614) 436-3870 |
| NPI Number | 1023620879 |
|---|---|
| Provider Enumeration Date | 08/21/2020 |
| Last Update Date | 10/13/2021 |
| Medicare PECOS PAC ID | 6103246616 |
|---|---|
| Medicare Enrollment ID | O20201022002639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023620879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Marvin S Im |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154436665 PECOS PAC ID: 0042216889 Enrollment ID: I20061018000361 |
| Provider Name | Brittany S Witham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568836633 PECOS PAC ID: 0749582088 Enrollment ID: I20160105000034 |
| Provider Name | Elizabeth Trent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265934061 PECOS PAC ID: 5991039125 Enrollment ID: I20190621002536 |
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