1295808202 NPI number — COL MANAGEMENT, LLC

Table of content: (NPI 1295808202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295808202 NPI number — COL MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COL MANAGEMENT, 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:
TOMOGRAPHY CENTER OF COLUMBUS, LLC
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:
1295808202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4906 AMBASSADOR CAFFERY PARKWAY
Provider Second Line Business Mailing Address:
BUILDING F
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-291-9161
Provider Business Mailing Address Fax Number:
337-289-0593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2526 5TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39705-2019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-328-8402
Provider Business Practice Location Address Fax Number:
662-328-1554
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
337-291-9161

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07727374 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00147271 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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