Basic Information
| Provider Information | |||||||||
| NPI: | 1992724868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLUMBUS SPEECH AND HEARING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 E NORTH BROADWAY ST | ||||||||
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| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432144114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142635151 | ||||||||
| FaxNumber: | 2612655365 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 E NORTH BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432144114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142635151 | ||||||||
| FaxNumber: | 2612655365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 03/05/2021 | ||||||||
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| AuthorizedOfficialLastName: | DYE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | OLIVER | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6142635151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 0318800 | 05 | OH | MEDICAID |