Provider Demographics
NPI:1528055613
Name:GAHANNA URGENT CARE
Entity type:Organization
Organization Name:GAHANNA URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIIULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-433-9200
Mailing Address - Street 1:1875 TAMARACK CIR N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4577
Mailing Address - Country:US
Mailing Address - Phone:614-433-9200
Mailing Address - Fax:614-433-9201
Practice Address - Street 1:5610 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1324
Practice Address - Country:US
Practice Address - Phone:614-476-1112
Practice Address - Fax:614-476-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care