Basic Information
| Provider Information | |||||||||
| NPI: | 1710297288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT CARMEL HEALTH PROVIDERS III, LLC | ||||||||
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| OtherOrganizationName: | MOUNT CARMEL HEALTH STATIONS AT FIRST CHURCH OF GOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6150 EAST BROAD STREET | ||||||||
| Address2: | 2ND FLOOR WH 233 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432131574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145464400 | ||||||||
| FaxNumber: | 6145464441 | ||||||||
| Practice Location | |||||||||
| Address1: | 3480 REFUGEE ROAD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432324814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142354039 | ||||||||
| FaxNumber: | 6142354021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 10/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6145464969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.