Basic Information
| Provider Information | |||||||||
| NPI: | 1386646131 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBUS HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 N 13TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071071317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732681400 | ||||||||
| FaxNumber: | 9732681523 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 N 13TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071071317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732681400 | ||||||||
| FaxNumber: | 9732681523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITE | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9732681400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 10703 | NJ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 3676706 | 05 | NJ | MEDICAID |