Provider Demographics
NPI:1699556746
Name:INDEPENDENCE HEALTHCARE LLC
Entity type:Organization
Organization Name:INDEPENDENCE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KHADIE
Authorized Official - Middle Name:MURIEL
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:614-893-6800
Mailing Address - Street 1:4595 WALNUT RD STE L
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:43008-7909
Mailing Address - Country:US
Mailing Address - Phone:740-822-0080
Mailing Address - Fax:740-822-0081
Practice Address - Street 1:4595 WALNUT RD STE L
Practice Address - Street 2:
Practice Address - City:BUCKEYE LAKE
Practice Address - State:OH
Practice Address - Zip Code:43008-7909
Practice Address - Country:US
Practice Address - Phone:740-822-0080
Practice Address - Fax:740-822-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center