| Town Street Medical, Llc | |
|
1547 W Broad St Columbus OH 43222-1043 | |
| (614) 221-3300 | |
| (614) 221-7858 |
| Full Name | Town Street Medical, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1547 W Broad St, Columbus, Ohio |
| Authorized Official Name and Position | Mona Royder (CEO) |
| Authorized Official Contact | 6142848073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Town Street Medical, Llc 1809 Drury Ln Nichols Hills OK 73116-5311 Ph: (614) 284-8073 | Town Street Medical, Llc 1547 W Broad St Columbus OH 43222-1043 Ph: (614) 221-3300 |
| NPI Number | 1922464437 |
|---|---|
| Provider Enumeration Date | 01/13/2016 |
| Last Update Date | 03/27/2017 |
| Medicare PECOS PAC ID | 2567767882 |
|---|---|
| Medicare Enrollment ID | O20160224003052 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922464437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | OH34-003964 (Ohio) | Primary |
| Provider Name | Dwight Keith Carson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417068776 PECOS PAC ID: 4688763907 Enrollment ID: I20071210000002 |
| Provider Name | Madelyn R Sartain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649356304 PECOS PAC ID: 3072707090 Enrollment ID: I20101103000414 |
| Provider Name | Ashley Degutis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003212382 PECOS PAC ID: 2860710688 Enrollment ID: I20150407001981 |
| Provider Name | Laura Lynn Mcneil |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962897769 PECOS PAC ID: 6800194028 Enrollment ID: I20160420002206 |
| Provider Name | Linna Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457711871 PECOS PAC ID: 3274789466 Enrollment ID: I20160617000432 |
| Provider Name | Veronica M Tarkenton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750714390 PECOS PAC ID: 6507090230 Enrollment ID: I20161003001913 |
| Provider Name | Rachael Westfall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992216659 PECOS PAC ID: 9739448754 Enrollment ID: I20180122000934 |
| Provider Name | Amy R Mccaul |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982168944 PECOS PAC ID: 0143641035 Enrollment ID: I20200601002971 |
| Provider Name | Karl Hagen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033185848 PECOS PAC ID: 7911036769 Enrollment ID: I20210610001543 |
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