Basic Information
| Provider Information | |||||||||
| NPI: | 1699748343 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS UROLOGY INC | ||||||||
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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 LN | ||||||||
| Address2: | STE 3C | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432141419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145382222 | ||||||||
| FaxNumber: | 6145382233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 09/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | SIMON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | SR PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6145382222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.