1447450804 NPI number — COLON & RECTAL DISEASE CENTER, INC.

Table of content: (NPI 1447450804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447450804 NPI number — COLON & RECTAL DISEASE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON & RECTAL DISEASE 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:
Provider Other Organization Name Type Code:
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:
1447450804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10496 MONTGOMERY RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45242-5220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-793-9835
Provider Business Mailing Address Fax Number:
513-793-9837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10496 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-793-9835
Provider Business Practice Location Address Fax Number:
513-793-9837
Provider Enumeration Date:
07/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MATTA
Authorized Official First Name:
MAHENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
513-793-9835

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com