1720097587 NPI number — CENTRAL OHIO ENDOCRINOLOGY

Table of content: (NPI 1720097587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720097587 NPI number — CENTRAL OHIO ENDOCRINOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO ENDOCRINOLOGY
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:
1720097587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5965 E BROAD ST
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43213-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-864-9581
Provider Business Mailing Address Fax Number:
614-864-5649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5965 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-864-9581
Provider Business Practice Location Address Fax Number:
614-864-5649
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BHASIN
Authorized Official First Name:
ROMI
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
614-864-9581

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  35-08-1117 , 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: 2339973 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC0189 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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