Provider Demographics
NPI:1104123421
Name:NORTHSIDE WOMENS HEALTH LLC
Entity type:Organization
Organization Name:NORTHSIDE WOMENS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-865-7600
Mailing Address - Street 1:550 S. CLEVELAND AVE
Mailing Address - Street 2:STE D
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8958
Mailing Address - Country:US
Mailing Address - Phone:614-865-7600
Mailing Address - Fax:614-392-2546
Practice Address - Street 1:550 S. CLEVELAND AVE
Practice Address - Street 2:STE D
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8958
Practice Address - Country:US
Practice Address - Phone:614-865-7600
Practice Address - Fax:614-392-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083614174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075546Medicaid