Provider Demographics
NPI:1235595653
Name:T J HEALTH COLUMBIA INC
Entity Type:Organization
Organization Name:T J HEALTH COLUMBIA INC
Other - Org Name:T J HEALTH COLUMBIA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-651-4159
Mailing Address - Street 1:PO BOX 645996 CINCINNATI
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-0001
Mailing Address - Country:US
Mailing Address - Phone:270-651-4444
Mailing Address - Fax:270-651-4892
Practice Address - Street 1:902 WESTLAKE DR STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1149
Practice Address - Country:US
Practice Address - Phone:270-384-0451
Practice Address - Fax:270-384-0454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TJ REGIONAL HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-14
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100422710Medicaid
KYK209780Medicare PIN
KY183970Medicare PIN