1578999553 NPI number — CENTRAL OHIO SPECIALTY CARE, LLC

Table of content: (NPI 1578999553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578999553 NPI number — CENTRAL OHIO SPECIALTY CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO SPECIALTY CARE, 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:
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:
1578999553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2349 WESTBROOKE DR
Provider Second Line Business Mailing Address:
BLDG A
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43228-9557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-790-0200
Provider Business Mailing Address Fax Number:
614-754-5084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2349 WESTBROOKE DR
Provider Second Line Business Practice Location Address:
BLDG A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43228-9557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-790-0200
Provider Business Practice Location Address Fax Number:
614-754-5084
Provider Enumeration Date:
09/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KALOGERAS
Authorized Official First Name:
NICK
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
614-790-0200

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: HMER.22969-JCHO , 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: 0118529 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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