Basic Information
| Provider Information | |||||||||
| NPI: | 1104991371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONSOLIDATED MEDICAL SPECIALISTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12626 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432120626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148701234 | ||||||||
| FaxNumber: | 6148703199 | ||||||||
| Practice Location | |||||||||
| Address1: | 4930 W BROAD ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432281696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148701234 | ||||||||
| FaxNumber: | 6148703199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 10/01/2007 | ||||||||
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| AuthorizedOfficialLastName: | EMLICH | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6148701234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.O., F.A.C.O.I. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34-004432 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0008X | 34-004432 | OH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | 207RG0100X | 34-004432 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.