Basic Information
| Provider Information | |||||||||
| NPI: | 1114397577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS REGIONAL HEALTH PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3875 W PRESIDENTIAL WAY | ||||||||
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| City: | EDINBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461249058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123733025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 103 WILLOW ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NASHVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474487605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8129882223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2015 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | SONDERMAN | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 8123348958 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.