1598816514 NPI number — COLUMBUS EAST INTERNAL MEDICINE

Table of content: (NPI 1598816514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598816514 NPI number — COLUMBUS EAST INTERNAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS EAST INTERNAL MEDICINE
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:
1598816514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1075-A BEECHER CROSSING NORTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-8703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-475-6712
Provider Business Mailing Address Fax Number:
614-475-6902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1075 BEECHER XING N STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAHANNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43230-4572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-475-6712
Provider Business Practice Location Address Fax Number:
614-475-6902
Provider Enumeration Date:
01/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRAVERMAN
Authorized Official First Name:
LISA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
614-475-6712

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35062326 , 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: 2073616 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".