Aetna Provider Service

NPI #1770972143 in Blacklick, Ohio

Provider Information

NPI Number: 1770972143
Entity Type: Organization
Organization Name: Aetna Provider Service
Primary Specialty: In Home Supportive Care
Enumeration Date: Jan 22, 2015
Last Updated: Jan 22, 2015

Practice Location

Address: 8514 ARLEN DRIVE
City: Blacklick
State: Ohio
ZIP Code: 43004
Phone: (614) 946-5475

Authorized Official

Name: MEMUNATU SHERIFF
Title: INDEPENDENT PROVIDER
Phone: (614) 946-5475

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
In Home Supportive Care	253Z00000X	Primary

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