Basic Information
| Provider Information | |||||||||
| NPI: | 1104998624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 EAST 17TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123794441 | ||||||||
| FaxNumber: | 8123765963 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 EAST 17TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123794441 | ||||||||
| FaxNumber: | 8123765963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | WEATHERWAX | ||||||||
| AuthorizedOfficialFirstName: | MARLENE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO VP OF FINANCIAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8123765205 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | IN | N | Hospital Units | Psychiatric Unit | 273Y00000X | IN | N | Hospital Units | Rehabilitation Unit | 341600000X | IN | N | Transportation Services | Ambulance | 282N00000X | IN | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100268200A | 05 | IN | MEDICAID | 100293890A | 05 | IN | MEDICAID | 000000054333 | 01 | IN | BLUE CROSS | OTHER | 100454010A | 05 | IN | MEDICAID | 100268190A | 05 | IN | MEDICAID |