Basic Information
| Provider Information | |||||||||
| NPI: | 1255507430 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTH PROVIDERS TWO LLC | ||||||||
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| OtherOrganizationName: | COLUMBUS CARDIOLOGY CONSULTANTS OF MOUNT CARMEL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 951144 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441930005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145464400 | ||||||||
| FaxNumber: | 6145464441 | ||||||||
| Practice Location | |||||||||
| Address1: | 6670 PERIMETER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430168056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143392780 | ||||||||
| FaxNumber: | 6142218869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHUTTE | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6145464424 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.