Provider Demographics
NPI:1124027057
Name:COLUMBUS OBSTETRICIANS - GYNECOLOGISTS, INC.
Entity Type:Organization
Organization Name:COLUMBUS OBSTETRICIANS - GYNECOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANMETER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:614-434-2444
Mailing Address - Street 1:750 MOUNT CARMEL MALL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-434-2400
Mailing Address - Fax:614-434-2499
Practice Address - Street 1:1310 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7814
Practice Address - Country:US
Practice Address - Phone:614-434-2400
Practice Address - Fax:614-434-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCO9930604207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165048Medicaid
OHCO9930604Medicare ID - Type Unspecified