1508050485 NPI number — CENTRAL OHIO SPORTS MEDICINE AND ORTHOPEDICS INCORPORATED

Table of content: (NPI 1508050485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508050485 NPI number — CENTRAL OHIO SPORTS MEDICINE AND ORTHOPEDICS INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO SPORTS MEDICINE AND ORTHOPEDICS INCORPORATED
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:
6
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:
1508050485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 N MURRAY HILL RD
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:
43228-1585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-878-6182
Provider Business Mailing Address Fax Number:
614-878-1922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 N MURRAY HILL RD
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:
43228-1585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-878-6182
Provider Business Practice Location Address Fax Number:
614-878-1922
Provider Enumeration Date:
09/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LADU
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-878-6182

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  34005826 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0671269 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 294741914013 . This is a "MEDICAL MUTUAL OF OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG8198 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000543334 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32054993301 . This is a "MEDICAL MUTUAL OH OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000543295 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000543336 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2024893 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: PO0456788 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000543304 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 121264245001 . This is a "MEDICAL MUTUAL OF OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0048095 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: PO0456787 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PO0456789 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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