1679511182 NPI number — COLUMBUS VASCULAR MEDICINE INC

Table of content: THEA ANGELA VADEN CNM (NPI 1114068889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679511182 NPI number — COLUMBUS VASCULAR MEDICINE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS VASCULAR MEDICINE 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:
1679511182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 E STATE ST
Provider Second Line Business Mailing Address:
STE 460A
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43215-4354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-228-8272
Provider Business Mailing Address Fax Number:
614-228-8271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 E STATE ST
Provider Second Line Business Practice Location Address:
STE 460A
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-4354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-228-8272
Provider Business Practice Location Address Fax Number:
614-228-8271
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLAYBAUGH
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-228-8272

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35071159S , 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: 2824555 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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