1962400044 NPI number — COA ASC OF FRANKLIN COUNTY LLC

Table of content: (NPI 1962400044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962400044 NPI number — COA ASC OF FRANKLIN COUNTY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COA ASC OF FRANKLIN COUNTY 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:
1962400044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1A BURTON HILLS BLVD # L&C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-665-1283
Provider Business Mailing Address Fax Number:
615-234-1720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5965 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-751-4080
Provider Business Practice Location Address Fax Number:
614-751-4092
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SNODGRASS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0010AS , 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: 490002923 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0335186 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000208628 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com