Basic Information
| Provider Information | |||||||||
| NPI: | 1316989551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS COMMUNITY HEALTH REGIONAL SLEEP DISORDERS CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 W THIRD AVE | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144437800 | ||||||||
| FaxNumber: | 6142993406 | ||||||||
| Practice Location | |||||||||
| Address1: | 1430 S HIGH STREET | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432071045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144437800 | ||||||||
| FaxNumber: | 6144436960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6144437800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.