Basic Information
| Provider Information | |||||||||
| NPI: | 1962596254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS RADIOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 E 17TH ST | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123794441 | ||||||||
| FaxNumber: | 8123732114 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 E 17TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123794441 | ||||||||
| FaxNumber: | 8123732114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HASSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8123794441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.