1750820908 NPI number — COLUMBUS MEDICAL SERVICES, LLC

Table of content: (NPI 1750820908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750820908 NPI number — COLUMBUS MEDICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBUS MEDICAL SERVICES, 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:
1750820908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E SWEDESFORD RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 W EXECUTIVE DR STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-1046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-229-5116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NOLAN
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. PROJECT MANAGER
Authorized Official Telephone Number:
800-229-5116

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000979052F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000979052J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000979052K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1512668 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000979052D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000979052H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000979052I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201212480A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201087800A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000979052G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000979052E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101287500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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