1023136587 NPI number — EDWARD L. COLBY D.O. INC.

Table of content: (NPI 1023136587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023136587 NPI number — EDWARD L. COLBY D.O. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD L. COLBY D.O. 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:
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:
1023136587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61353 SOUTHGATE RD
Provider Second Line Business Mailing Address:
SUITE#6
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43725-6607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-432-3434
Provider Business Mailing Address Fax Number:
740-432-4035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61353 SOUTHGATE RD
Provider Second Line Business Practice Location Address:
SUITE#6
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43725-6607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-432-3434
Provider Business Practice Location Address Fax Number:
740-432-4035
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLBY
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-432-3434

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  34004997 , 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: 000000119977 . This is a "COMMUNITY MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 298728719002 . This is a "MED MUTUAL ED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2341344 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0879830 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 295500551002 . This is a "MED MUTUAL LINDA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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