1922464437 NPI number — TOWN STREET MEDICAL, LLC

Table of content: (NPI 1922464437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922464437 NPI number — TOWN STREET MEDICAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN STREET MEDICAL, 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:
1922464437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 DRURY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NICHOLS HILLS
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-5311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-284-8073
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TOWN STREET MEDICAL LLC DBA COLUMBUS IMMEDIATE CARE
Provider Second Line Business Practice Location Address:
3781 S HIGH STREET
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43207-4011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-221-3300
Provider Business Practice Location Address Fax Number:
614-221-7858
Provider Enumeration Date:
01/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ROYDER
Authorized Official First Name:
MONA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
405-601-3330

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OH34-003964 , 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)





Copyright © 2007-2025 www.npivalidator.com