Basic Information
| Provider Information | |||||||||
| NPI: | 1548238371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLUMBER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1713 MARION MOUNT GILEAD RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433027867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837080 | ||||||||
| FaxNumber: | 7403862824 | ||||||||
| Practice Location | |||||||||
| Address1: | 1713 MARION MOUNT GILEAD RD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433027867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403838080 | ||||||||
| FaxNumber: | 7403862824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34-008126 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2462740 | 05 | OH | MEDICAID |