1669535373 NPI number — COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.

Table of content: (NPI 1669535373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669535373 NPI number — COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS NEIGHBORHOOD HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIMARYONE HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669535373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2780 AIRPORT DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43219-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-645-5500
Provider Business Mailing Address Fax Number:
614-645-5517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 PARSONS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-645-7487
Provider Business Practice Location Address Fax Number:
614-645-7080
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAVARES
Authorized Official First Name:
CHARLETA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
614-859-1946

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2390694 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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