1588837728 NPI number — POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.

Table of content: (NPI 1588837728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588837728 NPI number — POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, 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:
POMEGRANATE HEALTH SYSTEMS OF COLUMBUS
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:
1588837728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65418 BARKCAMP PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43718-9733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-782-1211
Provider Business Mailing Address Fax Number:
877-662-2747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
765 PIERCE DR.
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:
43223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-223-1650
Provider Business Practice Location Address Fax Number:
888-727-7834
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KASIRAJA
Authorized Official First Name:
CHINTA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
304-281-7011

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  10-5476 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: 10-2068 , 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: 0066655 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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