Basic Information
Provider Information
NPI: 1336255918
EntityType: 2
ReplacementNPI:  
OrganizationName: MOUNT CARMEL HEALTH SYSTEM
LastName:  
FirstName:  
MiddleName:  
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Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 3100 EASTON SQUARE PL STE 300
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432196290
CountryCode: US
TelephoneNumber: 7343433320
FaxNumber:  
Practice Location
Address1: 6435 E BROAD ST.
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432131507
CountryCode: US
TelephoneNumber: 6143558150
FaxNumber: 6143558151
Other Information
ProviderEnumerationDate: 08/23/2006
LastUpdateDate: 09/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PRIDAY
AuthorizedOfficialFirstName: ANDREW
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CHIEF FINANCIAL OFFICER
AuthorizedOfficialTelephone: 6145464146
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

ID Information
IDTypeStateIssuerDescription
009986805OH MEDICAID


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