1396780466 NPI number — CENTRAL OHIO UROLOGY GROUP, LLC

Table of content: (NPI 1396780466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396780466 NPI number — CENTRAL OHIO UROLOGY GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO UROLOGY GROUP, LLC
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:
GROUP & UA
Provider Other Organization Name Type Code:
5
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:
1396780466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 TECH CENTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-944-4806
Provider Business Mailing Address Fax Number:
614-944-4750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 TECH CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GAHANNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-396-2684
Provider Business Practice Location Address Fax Number:
614-396-2480
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIACOMELLI
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
614-396-2635

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1083883391 . This is a "DMERC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1144499237 . This is a "DMERC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1518136605 . This is a "DMERC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1811166986 . This is a "DMERC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2660820 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF0566 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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