1194965699 NPI number — CENTRAL OHIO PEDIATRIC ENDOCRINOLOGY & DIABETES SERV LLC

Table of content: (NPI 1194965699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194965699 NPI number — CENTRAL OHIO PEDIATRIC ENDOCRINOLOGY & DIABETES SERV LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL OHIO PEDIATRIC ENDOCRINOLOGY & DIABETES SERV 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:
6
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:
1194965699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 DILLMONT DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43235-6458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-839-3040
Provider Business Mailing Address Fax Number:
614-839-3041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 DILLMONT DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43235-6458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-839-3040
Provider Business Practice Location Address Fax Number:
614-839-3041
Provider Enumeration Date:
02/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ZIPF
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BYRON
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
614-839-3040

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: Z10493253 . This is a "MEDICARE INDIVIDUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: A79972 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0373760 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2044488 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE9314531 . This is a "MEDICARE GROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: E21314 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".




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