Provider Demographics
NPI:1154963999
Name:HETRICKKOENIGHEALTH, LLC
Entity type:Organization
Organization Name:HETRICKKOENIGHEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:HETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-831-8044
Mailing Address - Street 1:6695 THORNE ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2431
Mailing Address - Country:US
Mailing Address - Phone:646-831-8044
Mailing Address - Fax:614-957-8610
Practice Address - Street 1:885 HIGH ST STE 107
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4158
Practice Address - Country:US
Practice Address - Phone:614-368-7070
Practice Address - Fax:614-957-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty