Provider Demographics
NPI:1215102769
Name:RICHARD K. CAVENDER, MD,INC.
Entity type:Organization
Organization Name:RICHARD K. CAVENDER, MD,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-939-2308
Mailing Address - Street 1:615 COPELAND MILL RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8904
Mailing Address - Country:US
Mailing Address - Phone:614-939-2308
Mailing Address - Fax:614-939-2309
Practice Address - Street 1:615 COPELAND MILL RD STE 2D
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8904
Practice Address - Country:US
Practice Address - Phone:614-939-2308
Practice Address - Fax:614-939-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0776709Medicare PIN
OHF96529Medicare UPIN