Provider Demographics
NPI:1922971035
Name:PROFESSIONAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ASANTEWA
Authorized Official - Last Name:WADEI
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:614-446-0101
Mailing Address - Street 1:7602 SLATE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8157
Mailing Address - Country:US
Mailing Address - Phone:614-446-0101
Mailing Address - Fax:614-420-2229
Practice Address - Street 1:7602 SLATE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8157
Practice Address - Country:US
Practice Address - Phone:614-446-0101
Practice Address - Fax:614-420-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty