Provider Demographics
NPI:1487795795
Name:WHITEHALL MEDICAL CENTER INC
Entity type:Organization
Organization Name:WHITEHALL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:F
Authorized Official - Last Name:DILTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:614-235-9944
Mailing Address - Street 1:4254 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213
Mailing Address - Country:US
Mailing Address - Phone:614-235-9944
Mailing Address - Fax:614-235-9344
Practice Address - Street 1:4254 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-235-9944
Practice Address - Fax:614-235-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0198647Medicaid
OH0198647Medicaid