Basic Information
| Provider Information | |||||||||
| NPI: | 1083889752 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL OHIO UROLOGY GROUP, LLC | ||||||||
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| OtherOrganizationName: | COLUMBUS PROSTATE CANCER CENTER/MORRISON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 MORRISON RD | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432305327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149444770 | ||||||||
| FaxNumber: | 6149444771 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 MORRISON RD | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432305327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149444770 | ||||||||
| FaxNumber: | 6149444771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | GIACOMELLI | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6143962635 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.