Provider Demographics
NPI:1164098109
Name:COLUMBUS ONCOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:COLUMBUS ONCOLOGY ASSOCIATES INC
Other - Org Name:COLUMBUS ONCOLOGY ASSOCIATES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOURLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-442-3130
Mailing Address - Street 1:810 JASONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4359
Mailing Address - Country:US
Mailing Address - Phone:614-442-3142
Mailing Address - Fax:614-967-9183
Practice Address - Street 1:810 JASONWAY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4359
Practice Address - Country:US
Practice Address - Phone:614-442-3142
Practice Address - Fax:614-967-9183
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS ONCOLOGY ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-01
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy