1104831718 NPI number — COLUMBUS REGIONAL HOSPITAL

Table of content: (NPI 1104831718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104831718 NPI number — COLUMBUS REGIONAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS REGIONAL HOSPITAL
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:
MAJESTIC CARE OF BEDFORD
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:
1104831718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47201-5351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-379-4441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 NORTON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47421-4522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-279-4437
Provider Business Practice Location Address Fax Number:
812-277-2796
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BYERS
Authorized Official First Name:
GRANT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP AND CHIEF FINANCIAL OF
Authorized Official Telephone Number:
812-376-5644

Provider Taxonomy Codes

  • Taxonomy code: 311500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 313M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3140N1450X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100274460B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000098145 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100450900A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".