Basic Information
| Provider Information | |||||||||
| NPI: | 1336113133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMON | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 634172 | ||||||||
| Address2: | COLUMBUS UROLOGY INC | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452634172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148183576 | ||||||||
| FaxNumber: | 6148180217 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 THOMAS LANE | ||||||||
| Address2: | SUITE 3C COLUMBUS UROLOGY INC | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432141419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145382222 | ||||||||
| FaxNumber: | 6145382233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 12/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35 04 5354S | OH | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1900179 | 01 | UHC | OTHER | 000000116897 | 01 | ANTHEM | OTHER | 0449410 | 05 | OH | MEDICAID |