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6100 E Main St Ste 112 Columbus OH 43213-3399 | |
| (614) 948-5009 | |
| (614) 948-5018 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 6100 E Main St Ste 112, Columbus, Ohio |
| Authorized Official Name and Position | Vincent K Chu (CEO) |
| Authorized Official Contact | 6149753965 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6100 E Main St Ste 112 Columbus OH 43213-3399 Ph: (614) 948-5009 | 6100 E Main St Ste 112 Columbus OH 43213-3399 Ph: (614) 948-5009 |
| NPI Number | 1073147872 |
|---|---|
| Provider Enumeration Date | 03/02/2020 |
| Last Update Date | 11/19/2024 |
| Medicare PECOS PAC ID | 5496177826 |
|---|---|
| Medicare Enrollment ID | O20200612000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073147872 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Vincent K Chu |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1366481822 PECOS PAC ID: 3577526409 Enrollment ID: I20060627000084 |
| Provider Name | Omoefe Efetevbia |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1447299839 PECOS PAC ID: 9234300310 Enrollment ID: I20200612000889 |
| Provider Name | Jaeda C Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396008157 PECOS PAC ID: 6800216276 Enrollment ID: I20201023002004 |
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