Provider Demographics
NPI:1073063145
Name:CENTRAL OHIO BREAST AND ENDOCRINE SURGERY LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO BREAST AND ENDOCRINE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-547-1770
Mailing Address - Street 1:PO BOX 91330
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-7330
Mailing Address - Country:US
Mailing Address - Phone:614-636-2558
Mailing Address - Fax:614-505-7512
Practice Address - Street 1:1080 BEECHER XING N STE A
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4557
Practice Address - Country:US
Practice Address - Phone:614-547-1770
Practice Address - Fax:614-547-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074426Medicaid