Basic Information
| Provider Information | |||||||||
| NPI: | 1710971916 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACH | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20452 | ||||||||
| Address2: | COPA-CRED | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432200452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148736440 | ||||||||
| FaxNumber: | 6144422410 | ||||||||
| Practice Location | |||||||||
| Address1: | 793 W STATE ST | ||||||||
| Address2: | MT. CARMEL WEST HOSPITAL PATHOLOGY DEPT. | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432221551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142341300 | ||||||||
| FaxNumber: | 6142342931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 04/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 35068690 | OH | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0165495 | 05 | OH | MEDICAID | 0713197 | 05 | OH | MEDICAID | 118240 | 01 | OH | ANTHEM BCBS | OTHER | 220015720 | 01 | OH | RR MEDICARE | OTHER |