Provider Demographics
NPI:1033174081
Name:COLUMBUS UROLOGY INC
Entity Type:Organization
Organization Name:COLUMBUS UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-538-2222
Mailing Address - Street 1:PO BOX 634172
Mailing Address - Street 2:COLUMBUS UROLOGY INC
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-4172
Mailing Address - Country:US
Mailing Address - Phone:614-818-3576
Mailing Address - Fax:614-818-0217
Practice Address - Street 1:4845 KNIGHTSBRIDGE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2463
Practice Address - Country:US
Practice Address - Phone:614-273-0400
Practice Address - Fax:614-273-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO9927207Medicare PIN
OHCB3068Medicare PIN